Visiting, or interacting with, this website does not constitute an attorney-client relationship. Although we are always interested in hearing from visitors to our website, we cannot accept representation on a new matter from either existing clients or new clients until we know that we do not have a conflict of interest that would prevent us from doing so. Therefore, please do not send us any information about any new matter that may involve a potential legal representation until we have confirmed that a conflict of interest does not exist and we have expressly agreed in writing to the representation. Until there is such an agreement, we will not be deemed to have given you any advice, any information you send may not be deemed privileged and confidential, and we may be able to represent adverse parties.
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.
Memberships
American Health Law Association (AHLA) — Fraud & Abuse Practice Group, Vice Chair (2008–2014), Advisory Opinion Task Force (2004–2008); Mentoring Program; Public Interest Contributor
American Bar Association — Health Law Section: Co-Chair, Planning Committee, Emerging Issues in Healthcare Law Conference (2022-present); Vice Chair, Planning Committee, Emerging Issues in Healthcare Law Conference (2017-2022); Vice Chair, Business & Transactions Interest Group (2009-2012)
Maryland State Bar Association
Serjeants Inn Law Club
U.S. Court of Appeals, Fourth Circuit Judicial Conference
Legal Aid Bureau —Young Lawyers Division, Past Board Member
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.
Memberships
American Health Law Association (AHLA) — Fraud & Abuse Practice Group, Vice Chair (2008–2014), Advisory Opinion Task Force (2004–2008); Mentoring Program; Public Interest Contributor
American Bar Association — Health Law Section: Co-Chair, Planning Committee, Emerging Issues in Healthcare Law Conference (2022-present); Vice Chair, Planning Committee, Emerging Issues in Healthcare Law Conference (2017-2022); Vice Chair, Business & Transactions Interest Group (2009-2012)
Maryland State Bar Association
Serjeants Inn Law Club
U.S. Court of Appeals, Fourth Circuit Judicial Conference
Legal Aid Bureau —Young Lawyers Division, Past Board Member
Representation of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Inc, one of New England’s premier, physician-led organizations dedicated to excellence in clinical care, education and research, career advancement, inclusivity, and well-being in its acquisition of Center for Medical Simulation, Inc., a provider of world-class healthcare simulation for a broad spectrum of providers. Terms of the transaction were not disclosed.
Regulatory support to AdhereRx Incorporated, a pharmacy company committed to long-term pharmacy support for high-risk patients, in its sale of certain assets to Exact Care Pharmacy, a national medication management and pharmacy care provider. Terms of the transaction were not disclosed.
Regulatory support to AdhereRx Incorporated, a pharmacy company committed to long-term pharmacy support for high-risk patients, in its sale of certain pharmacy assets to Curexa – West, LLC, a leading provider of compounding, packaging, labeling, and digital and traditional pharmacy solutions for telemedicine and medical providers, veterinarians, manufacturers, and clinical research organizations across the nation. Terms of the transaction were not disclosed.
“Joint Venture Guidance Going on 30 Years – Where Do We Go from Here?” AHLA Fraud and Compliance Forum (October 2023)
“Turn that Frown Upside Down: Finding Compliance with the Physician Self-Referral Law Instead of Violations,” AHLA Fraud and Compliance Forum (October 2022)
“How Do Healthcare Innovations Lead to New Enforcement Risks?” ABA Physicians Legal Issues Conference (September 2022)
“Hot Topics 2022: Focus on AKS/Stark,” ABA Civil False Claims 2022 Virtual Conference (September 2022)
“Health Law Fundamentals,” ABA Emerging Issues in Healthcare Law Conference (April 2022)
“Working With Health Care Boards to Mitigate Fraud and Abuse Risk Working with Health Care Boards to Mitigate Fraud and Abuse Risk,” AHLA Webinar (February 2022)
“The Role of Boards of Directors and How to Interact with Them,” AHLA Fraud and Compliance Forum (October 2021)
“Co-Management Arrangements in Healthcare: Compliance in Hospital-Physician Arrangements,” Strafford webinar (October 2021)
“Compliance and Ethics Programs: Where Risk, Data, and QAPI Intersect,” AHCA/NCAL Convention & Expo (October 2021)
“Structuring Gainsharing Arrangements and Bundled Payments,” Strafford Webinar (March 2017)
“What Every Seasoned Transactional Health Care Lawyer Should Know about Key Regulatory Elements of a Health Care Transaction, Part V: Common Regulatory Pitfalls in Acquisitions: the Stark Law, AKS and FCA,” AHLA webinar (May 2016)
“Deciphering the Self-Disclosure Puzzle,” Emerging Issues in Healthcare Law program, American Bar Association’s Health Law Section (February 2014)
“Update from the OIG,” D.C. Bar (December 2013)
“Cutting Through the Buzz to Get to the Hot Risk Areas for DME Suppliers,” Medtrade Conference (October 2012)
“Healthcare Fraud and Abuse Bootcamp Webinar Series, Part VI: Trends in Government Enforcement and Best Practices for Investigating and Defending Healthcare Fraud Actions,” AHLA webinar (June 2012)
“Legal & Investigational Issues with Short Stays,” AHLA, Institute on Medicare and Medicaid Payment Issues (March 2012)
“Practical Side of Investigating And Reporting Overpayments,” ABA Health Law Section, Emerging Issues in Healthcare Law Conference (February 2012)