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For hospital systems, home health and hospice, physician groups, dental organizations and other healthcare providers, Lauren Gaffney analyzes and counsels clients on the regulatory requirements and operational impacts related to day-to-day operations, including those related to fraud and abuse. Lauren also focuses on internal investigations, which involve responding to governmental inquiries regarding potential regulatory, compliance and clinical issues.
Recognizing that the landscape of healthcare law is constantly changing, Lauren advises clients on business decisions related to delivering superior patient care, within a heavily regulated industry. Her experience includes former positions as operations counsel intern for Hospital Corporation of America (HCA Inc.) and as an intern for Vanderbilt University Risk and Insurance Management.
For hospital systems, long-term care providers, physician groups, laboratories and other healthcare providers, Lauren Gaffney analyzes and counsels clients on the regulatory requirements and operational impacts related to day-to-day operations, including those related to fraud and abuse. Lauren also focuses on internal investigations, which involve responding to governmental inquiries regarding potential regulatory, compliance and clinical issues.
Lauren’s practice involves:
Government Enforcement & Compliance – Representing clients in government enforcement & compliance matters, including:
Drafting and revising compliance program documents, including codes of conduct, policies and procedures, forms, job descriptions and checklists for risk areas in anticipation of government investigations or inquiries.
Developing and presenting compliance training programs to boards of directors, officers, and clinical and administrative staff.
Conducting internal investigations, including coordinating the hiring of outside statistical, coding or billing experts.
Providing advice on the reporting and repayment of overpayments, as appropriate, including representing clients in self-disclosures, including disclosures made through self-referral (Stark) and OIG disclosure protocols.
Representing clients in responding to and, if necessary, appealing the results of payor claims audits, including those performed by Recovery Auditors f/k/a Recovery Audit Contractors (RACs), Program Safeguard Contractors (PSCs) n/k/a Zone Program Integrity Contractors (ZPICs), Uniform Program Integrity Contractors (UPICs), Medicaid Integrity Contractors (MICs) and State Medicaid Agencies.
Certificate of Need & CON Hearings – Representing a wide array of healthcare providers – including ambulatory surgery centers, nonprofit hospitals, imaging centers, outpatient diagnostic centers, physician practice groups, rehabilitation centers and others – in connection with the regulatory approvals needed to proceed with new service lines or major capital projects. Recent projects include the approval of three $100 million proton beam therapy facilities being developed in Tennessee.
Regulatory & Administrative Proceedings – In addition to CON proceedings, representing clients in regulatory and administrative matters before state and federal agencies, including the Tennessee Ethics Commission, the Tennessee Department of Health, the Tennessee Board of Medical Examiners, the Medicare Appeals Council, and others.
Mergers & Acquisitions – Advising a variety of national healthcare companies in mergers and other business combinations, as well as providing analysis on the compliance, regulatory and operational implications of potential transactions.
Recognizing that the landscape of healthcare law is constantly changing, Lauren advises clients on business decisions related to delivering superior patient care, within a heavily regulated industry. Her experience includes former positions as operations counsel intern for Hospital Corporation of America (HCA Inc.) and as an intern for Vanderbilt University Risk and Insurance Management.
Memberships
American Health Law Association (AHLA)
Health Care Compliance Association
Nashville Health Care Council — Leadership Health Care
Tennessee Bar Association
Nashville Emerging Leaders — Class of 2014
For hospital systems, home health and hospice, physician groups, dental organizations and other healthcare providers, Lauren Gaffney analyzes and counsels clients on the regulatory requirements and operational impacts related to day-to-day operations, including those related to fraud and abuse. Lauren also focuses on internal investigations, which involve responding to governmental inquiries regarding potential regulatory, compliance and clinical issues.
Recognizing that the landscape of healthcare law is constantly changing, Lauren advises clients on business decisions related to delivering superior patient care, within a heavily regulated industry. Her experience includes former positions as operations counsel intern for Hospital Corporation of America (HCA Inc.) and as an intern for Vanderbilt University Risk and Insurance Management.
Memberships
American Health Law Association (AHLA)
Health Care Compliance Association
Nashville Health Care Council — Leadership Health Care
Assisted multi-state behavioral health and addiction care company in analyzing the potential ramifications of Southeastern state’s medical board investigation of client’s providers in response to complaint regarding potential violations of Controlled Substances Act.
Successfully defended regional home health agency in a responding to an audit conducted by OIG-OAS and appealing the results recommended in the OIG-OAS final report
Successfully defended a home health agency in a responding to an audit conducted by the OIG-OAS and appealing the results recommended in the OIG-OAS final report
We have successfully represented several hospitals in making self-reports of potential violations of the Emergency Medical Treatment and Labor Act (EMTALA). After consideration of the self-reports, the Centers for Medicare & Medicaid (CMS) , Successful Defense of Home Health Agency in OIG-OAS Audit
We successfully defended a regional hospice in a responding to an audit conducted by the Office of Audit Services of the Health and Human Services’ Office of Inspector General (OIG-OAS) and appealing the results recommended in the OIG-OAS final report. Our representation resulted in a reduction of the original overpayment in the OIG-OAS final report from $7.3 million to $79,000 on appeal.
Lead counsel to West Tennessee Healthcare in obtaining a Certificate of Need (CON) to convert its existing hospital-based outpatient surgery center to a freestanding multi-specialty surgery center that will provide state-of-the art services
