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.

Compliance Task Force

Keeping up with the ever-changing tangle of complex regulations healthcare organizations face is tough enough. In recent years, the federal government has devoted additional financial resources to fighting fraud in healthcare and also authorized private contractors to scrutinize healthcare providers for Medicare and Medicaid fraud and abuse, such as RAC and ZPIC audits. Additionally, the Patient Protection and Affordable Care Act requires all Medicare and Medicaid providers to implement a compliance program.

A strong, robust compliance program to protect your healthcare organization has never been more important.

To assist our clients in meeting this challenge, Bass, Berry & Sims established a Compliance Task Force. This group of attorneys and other professionals brings significant experience in all aspects of developing, implementing and improving compliance programs for healthcare providers. We counsel clients on all of the elements needed to craft a comprehensive compliance program under the standards of the Federal Sentencing Guidelines and the HHS-OIG’s Compliance Program Guidance.

The task force has worked with providers in numerous industry sectors across the continuum of care, from hospitals and multi-hospital health systems and ambulatory surgery centers to post-acute providers and durable medical equipment suppliers.

Members of our Compliance Task Force frequently speak on healthcare compliance to local and national groups, publish articles and network with other compliance professionals through our membership in leading organizations in the field, such as the Health Care Compliance Association and the American Health Law Association. By applying our sophisticated, experienced counsel to the multitude of issues that face highly regulated healthcare services providers, we produce cost-effective and practical solutions to improve our clients’ compliance programs.

Philip F. Berg
Senior Healthcare Attorney
Kristin M. Bohl
Justin K. Brown
Stefanie P. Carter
Healthcare Attorney
Meredith Edwards Collins
Krista Cooper
Senior Healthcare Attorney
Jeffrey I. Davis
Mary Beth Fortugno
Lauren M. Gaffney
Leslie Demaree Goldsmith
Anna M. Grizzle
Clint D. Hermes
Michael R. Hill
Travis G. Lloyd
William T. Mathias
Jennifer  E. Michael
Amy Sanders Morgan
Christine M. Morse
Elaine C. Naughton
Brianna R. Powell
Lisa S. Rivera
Laurence B. Russell
Danielle M. Sloane
Page Minton Smith
Greg Stevens
Senior Counsel
Julia Tamulis
Nesrin Garan Tift
Shannon Wiley

Our healthcare attorneys encompass the multitude of legal specialties necessary to service one of the largest, most highly regulated industries in the United States. We bring our multidisciplinary, team approach to our representation of the following sectors and facilities:

  • Academic medical centers.
  • Ambulatory surgery centers.
  • Behavioral health.
  • Cancer therapy.
  • Clinical laboratories.
  • Dermatology.
  • Diagnostic imaging.
  • Health plans, managed care companies and benefit management companies.
  • Healthcare information technology.
  • Home health.
  • Hospice.
  • Hospitals and health systems.
  • Life sciences.
  • Managed care.
  • Medical device.
  • Nonprofit providers.
  • Orthotics and prosthetics.
  • Pharmaceuticals and pharmacies.
  • Physician practices, outsourced physician services and management companies.
  • Private equity.
  • Real Estate Investment Trusts (REITs).
  • Revenue cycle management.
  • Senior housing and long-term care.
  • Specialty pharmacy and pharmaceuticals.
  • Telemedicine.
  • Urgent and retail care clinics.
  • Wellness and disease management.