Anna M. Grizzle
With over 20 years of experience, Anna Grizzle helps healthcare clients address enforcement and compliance issues and respond to legal and regulatory violations. She regularly advises healthcare companies and providers on reimbursement, fraud and abuse, operations and transaction matters. 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.
Representing national hospitals, health systems, hospices, home health agencies, ambulatory surgery centers, behavioral and substance abuse providers, and physician practices, 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 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 physician self-referral (Stark) and Health and Human Services’ Office of Inspector General (HHS-OIG) disclosure protocols.
- Representing clients in responding to and, if necessary, appealing the results of payor claims audits and payment suspensions arising from 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, and audits conducted by the HHS-OIG Office of Audit Services (OIG-OAS).
- Assisting clients in resolving any issues with enforcement authorities, if audit results are referred to law enforcement, and addressing potential revocation of billing rights and other administrative actions.
- 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 OIG, United States Department of Justice, the Centers for Disease Control and Prevention, state Attorney Generals’ offices, and state regulatory agencies.
- EMTALA Matters – Representing hospitals in various matters related to the Emergency Medical Treatment and Labor Act (EMTALA), including:
- Assisting in responding to Statements of Deficiencies, including immediate jeopardy findings, and preparing Plans of Correction to address the cited deficiencies.
- Representing hospitals in EMTALA reviews conducted by Quality Improvement Organizations (QIOs), including preparation of written submissions and meeting presentations.
- Successfully representing before HHS-OIG in resolving allegations of potential EMTALA violations without the assessment of civil monetary penalties or other sanctions.
- 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 conducting medical staff investigations and hearings, and responding to records requests and subpoenas.
- Transactions – Providing advice on regulatory issues and operational implications in healthcare acquisitions, mergers, joint ventures and other business combinations.
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.
Featured Experience
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Successfully defended a number of clients across industry sectors, including hospitals, physician practices, hospices, home health agencies and DMEPOS suppliers, in appealing audit results where statistical sampling was used to calculate to extrapolated overpayment demands.
Memberships
Health Care Compliance Association
American Health Law Association (AHLA)
American Bar Association — Women in White Collar Subcommittee
Representative Experience
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Successfully defended a number of clients across industry sectors, including hospitals, physician practices, hospices, home health agencies and DMEPOS suppliers, in appealing audit results where statistical sampling was used to calculate to extrapolated overpayment demands.
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We served as lead outside counsel in working with a multi-hospital non-profit health system to develop and launch its Hospital at Home program, an innovative initiative that will allow eligible patients to heal from the comfort of their home rather than a hospital room. Our team analysed the potential options for structuring the program, provided advice on the state and federal regulatory requirements, worked with the in-house legal team to develop overall strategy, drafted template agreements and other required documents, and provided advice and support through the waiver processes administered by the Centers for Medicare & Medicaid and state department of health. We continue to provide legal advice on the day-to-day operations and expansion of the program.
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We successfully defended a regional home health agency 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 multi-million dollar overpayment in the OIG-OAS final report by 30 percent and recoupment to less than $10,000.
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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.
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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
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We successfully defended a home health agency 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 over $7 million to $79,000 on appeal.
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We have successfully represented a multi-hospital non-profit health system in negotiating practice leases with several physician groups in specialties including orthopedics, gastroenterology and urology.
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Successful defense of a national hospice provider against Centers for Medicare & Medicaid Services’ (CMS) determination that the provider failed to meet Hospice Quality Reporting Program (HQRP) requirements for Calendar Year 2021. This alleged non-compliance would have resulted in a 2% reduction in the provider’s annual payment update for Fiscal Year (FY) 2023. Through the HQRP reconsideration process, Bass Berry & Sims successfully demonstrated that CMS’ determination of non-compliance was erroneous because CMS’ inadvertent termination of the provider caused a systemic problem with the provider’s submission of requisite HQRP, Hospice Item Set data. At reconsideration, CMS reversed its initial determination of non-compliance and granted the provider the full FY 2023 annual payment update.
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Successful defense of two agencies of a national hospice provider against Centers for Medicare & Medicaid Services’ (CMS) determination that the provider failed to meet Hospice Quality Reporting Program (HQRP) requirements for Calendar Year 2021. This alleged non-compliance by both agencies would have resulted in a 2% reduction in the provider’s annual payment update for Fiscal Year (FY) 2023. Through the HQRP reconsideration process, Bass Berry & Sims successfully demonstrated that, despite guidance to the contrary, CMS’ non-compliance determination erroneously included timeframes in which each provider was not responsible for submitting HQRP, Hospice Item Set data. When such inappropriate time periods were excluded from consideration, both providers clearly satisfied HQRP requirements. Therefore, CMS reversed its initial determination of non-compliance and granted the provider the full FY 2023 annual payment update.
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Representation of Tennessee Oncology, PLLC, in an investigation of False Claims Act allegations arising from a qui tam case filed in the Middle District of Tennessee by a former hospital employee who alleged Tennessee Oncology provided radiation oncology treatment without appropriate supervision and prostate cancer treatment without complying with applicable documentation requirements. Following its investigation, the Department of Justice declined to intervene in the action, and the relator dismissed the case. Ferren v. HCA Health Services of Tennessee, et al. (M.D. Tenn.)
Publications
Upcoming Events
Past Events
Media Mentions & Firm News
Accolades
Chambers USA — Healthcare: Regulatory (2016-2022)
The Best Lawyers in America© — Health Care Law; Litigation: Health Care (2013-2023)
Best Lawyers® — Nashville Litigation: Health Care “Lawyer of the Year” (2022, 2017)
Nashville Business Journal “Best of the Bar” (2019)
Certified in Healthcare Compliance (CHC)®
Mid-South Super Lawyers (2018-2022); “Rising Star” (2011-2012)
Nashville Business Journal “Health Care Hero” (2015)
Nashville Business Journal “Forty Under 40” (2012)
Education
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University of Alabama School of Law - J.D., 1998
Order of the Coif
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Mississippi State University - B.A., 1994
Admissions
- Tennessee, 2000
- Alabama, 1998
- U.S. District Court, Eastern District of Tennessee, 2002
- U.S. Court of Appeals, Sixth Circuit, 2001
- U.S. District Court, Middle District of Tennessee, 2000
- U.S. District Court, Middle District of Alabama, 1998
- U.S. District Court, Northern District of Alabama, 1998
Chambers USA
"Anna Grizzle specializes in regulatory and compliance matters relating to healthcare transactions. 'Anna is an exceptional lawyer. She delivers quality results for her client.'"
From Chambers USA 2022
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