Bill Mathias is a healthcare regulatory attorney with a focus on fraud and abuse and Stark Law issues. He draws on over 25 years of experience to help national healthcare organizations address their thorniest healthcare regulatory issues.
He works with healthcare organizations to structure complex business arrangements, including joint ventures and strategic transactions, to manage risk while meeting their business objectives. Investors and healthcare organizations look to Bill to identify legal and compliance risks through due diligence and internal investigations and to devise strategies for managing legal risks and successfully resolving compliance issues.
Bill is a recognized authority on the federal Anti-Kickback Statute (AKS), the Stark Physician Self-Referral Law, the Eliminating Kickbacks in Recovery Act (EKRA) and the federal Civil Monetary Penalty regulations. He regularly assists with government investigations and defending False Claims Act lawsuits and other enforcement actions.
Bill Mathias is a healthcare regulatory attorney with a focus on fraud and abuse and Stark Law issues. He draws on over 25 years of experience to help national healthcare organizations address their thorniest healthcare regulatory issues.
He works with healthcare organizations to structure complex business arrangements, including joint ventures and strategic transactions, to manage risk while meeting their business objectives. Investors and healthcare organizations look to Bill to identify legal and compliance risks through due diligence and internal investigations and to devise strategies for managing legal risks and successfully resolving compliance issues.
Bill is a recognized authority on the federal Anti-Kickback Statute (AKS), the Stark Physician Self-Referral Law, the Eliminating Kickbacks in Recovery Act (EKRA) and the federal Civil Monetary Penalty regulations. He regularly assists with government investigations and defending False Claims Act lawsuits and other enforcement actions.
Some of the areas of emphasis in his practice include:
- Helping clients navigate the fraud and abuse risks and regulatory complexities surrounding the growing use of value-based arrangements.
- Advising hospitals and health systems on physician alignment strategies, such as joint ventures, co-management agreements and gainsharing arrangements.
- Working with healthcare companies to negotiate and operate under Corporate Integrity Agreements (CIAs) imposed by the Office of Inspector General (OIG).
- Developing compliance strategies for health systems and group purchasing organizations (GPOs) that allow them to pursue innovative supply chain management, purchasing programs, and discount arrangements.
- Providing regulatory counsel to Medicare Part B suppliers, including pharmacies, durable medical equipment (DME) and home medical equipment (HME) suppliers and infusion companies, on reimbursement, licensing and compliance issues.
- Developing compliance strategies for the Physician Payment Sunshine Act and the Centers for Medicare & Medicaid Services’ (CMS) Open Payments Program.
Bill has experience helping clients resolve issues through the voluntary self-disclosure protocols promulgated by the OIG and CMS. He also has obtained several favorable advisory opinions for clients from OIG. Bill played a leading role with the external monitor team that oversaw the compliance activities of a national kidney dialysis company under a CIA.
Previously, Bill was a shareholder at Ober|Kaler and Baker, Donelson, Bearman, Caldwell & Berkowitz, PC where he was co-chair of the Health Law Practice Group and the Fraud & Abuse Workgroup.
Following law school, Bill served as a law clerk to the Honorable Judge Joseph H. Young, U.S. District Court for the District of Maryland. Prior to law school, Bill was a Legislative Assistant to U.S. Representative Benjamin L. Cardin, a Member of the House Ways and Means Committee’s Health Subcommittee.
