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.

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    Client Type: Private Company
  • It was announced on Friday, November 18 that Evolent Health (NYSE: EVH) entered into a definitive agreement to acquire NIA...
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    Client Type: Private Company
  • 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.

    We successfully defended a national hospice provider against Centers for Medicare & Medicaid Services’ (CMS) determination that the provider failed...
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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.)

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  • We successfully defended a national home healthcare provider in appealing an $18 million extrapolated overpayment resulting from a UPIC audit.

    We successfully defended a national home healthcare provider in appealing an $18 million extrapolated overpayment resulting from a UPIC audit....
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    Client Type: Public Company
  • Representation of ProPath, the largest nationwide, fully physician operated pathology practice in the US, on day-to-day healthcare reimbursement, compliance and regulatory advice.

    Representation of ProPath, the largest nationwide, fully physician operated pathology practice in the US, on day-to-day healthcare reimbursement, compliance and...
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  • Representation of Physicians Group Laboratories (PGL), a laboratory service provider, on day-to-day healthcare reimbursement, compliance and regulatory advice.
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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.

    We successfully defended a number of clients across industry sectors, including hospitals, physician practices, hospices, home health agencies and DMEPOS...
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    Client Type: Public Company
  • Currently serve as outside counsel for one of the largest national hospice providers, handling audit response issues and appealing unfavorable audit results, which has resulted in overturning millions of dollars in overpayment demands.

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

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.