
Healthcare Compliance & Administrative Proceedings
Regulatory complexity and scrutiny are hallmarks of today's healthcare landscape. We have represented healthcare clients in connection with internal investigations regarding potential regulatory, compliance and clinical issues. Our experience includes representing clients in investigations conducted by the Office of Inspector General, United States Department of Justice, the Centers for Disease Control and Prevention, the Office for Civil Rights and state regulatory agencies.
We frequently work with clients to develop and implement compliance programs and provide advice on compliance-related matters. We work to develop policies in anticipation of government and commercial payer claims audits. These audits include those performed by Recovery Audit Contractors (RACs), Unified Program Integrity Contractors (UPICs) (formerly known as Zone Program Integrity Contractors (ZPICs)), and Medicaid Integrity Contractors (MICs). We routinely represent clients in responding to claims audits and in the appeals of audit results. This group counsels clients in antitrust regulatory requirements, corporate compliance programs and internal and government investigations.
Government audits of healthcare providers continue to increase in frequency and to evolve in nature and scope, and these audits bear serious consequences. At the outset of an audit, the firm can assist clients in responding to a request for medical records or help prepare for interviews conducted by auditors. In cases where an overpayment demand is received by the provider, we can assemble the coding professionals, statistical experts and independent medical experts necessary to formulate an appropriate response.
Experience
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We successfully defended a number of clients across industry sectors, including hospitals, physician practices, hospices, home health agencies and DMEPOS...
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We successfully defended a regional home health agency in a responding to an audit conducted by the Office of 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...
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We successfully defended a regional hospice in responding to an audit conducted by the Office of Audit Services of the...
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We provide outside general counsel services to a leading early stage healthcare technology company that uses objective data to measure...
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It was announced on Friday, November 18 that Evolent Health (NYSE: EVH) entered into a definitive agreement to acquire NIA...
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We successfully defended two agencies of a national hospice provider against Centers for Medicare & Medicaid Services’ (CMS) determination that...
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We successfully defended a national hospice provider against Centers for Medicare & Medicaid Services’ (CMS) determination that the provider failed...
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Lead counsel representing Tennessee Oncology, PLLC, in an investigation of False Claims Act allegations arising from a qui tam case...
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We defended a national home healthcare provider in appealing an $18 million extrapolated overpayment resulting from a UPIC audit. Through...