Anna M. Grizzle

With over 20 years of experience, Anna helps healthcare clients address enforcement and compliance issues and respond to legal and regulatory violations. With significant experience in defending against statistical sampling and extrapolation and claims denials in Medicare and Medicaid claims audits, Anna also has saved healthcare companies tens of millions of dollars in potential overpayment demands. She also advises healthcare companies on regulatory and compliance matters, including transactions involving mergers, acquisitions, joint ventures and dispositions.

Representing national hospitals, health systems, hospices, ambulatory surgery centers and a variety of other healthcare providers, laboratories and DMEPOS suppliers from many industry sectors, Anna’s practice involves:

• Government Enforcement & Compliance – Developing and implementing compliance programs based on the elements considered necessary for a comprehensive compliance program by the Federal Sentencing Guidelines and Office of Inspector General’s Compliance Program Guidance, including:
  • Drafting and revising compliance program documents, including Codes of Conduct, policies and procedures, forms, and job descriptions.
  • Developing and presenting compliance training programs to boards of directors, officers, and clinical and administrative staff.
  • Developing and reviewing policies, procedures, and audit checklists for risk areas in anticipation of government investigations or inquiries.
  • 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), Unified Program Integrity Contractors (UPICs), Medicaid Integrity Contractors (MICs) and State Medicaid Agencies.
  • Assisting clients in resolving any issues with enforcement authorities, if audit results are referred to law enforcement.
• Healthcare Fraud & Abuse – Representing clients in connection with False Claims Act litigation, self-disclosures, internal investigations and responding to governmental inquiries regarding potential regulatory, compliance and clinical issues, conducted by the Office of Inspector General, United States Department of Justice, the Centers for Disease Control and Prevention, state Attorney Generals’ offices, and state regulatory agencies.
• Contracting, Regulatory & Operational Matters – Counseling on healthcare operations and compliance, such as fraud and abuse, reimbursement, patient care, quality, and risk management issues, with extensive experience advising clients on medical staff credentialing and peer review matters, including drafting medical staff bylaws, conducting medical staff investigations and hearings, and responding to records requests and subpoenas.
• Mergers & Acquisitions – Advising a variety of national healthcare companies in mergers and other business combinations, as well as providing analysis on the regulatory and operational implications of potential transactions.
• Healthcare Disputes – Defending clients in medical malpractice actions and commercial litigation.

Anna’s leadership abilities and visionary judgment make her a go-to advisor in the healthcare sector. In addition, Anna is certified in healthcare compliance (CHC)®. Having served as a member of the firm’s Executive Committee, Anna is looked to as a trusted leader among her peers.