Biography

CHARLES C. DUNHAM, IV, is an Associate in the Health Care and Life Sciences practice, in the Houston and New York offices of Epstein Becker Green. He provides general counsel and representation to health care providers and health-related entities in a range of matters involving corporate formation and governance, business transactions and acquisitions, and health regulatory compliance. His national health law practice focuses on clinical and anatomic laboratories, hospitals and health systems, physician group practices and networks, long-term care facilities, telehealth practitioners and providers, and health IT companies.

Mr. Dunham’s experience includes the following:

  • Fraud and Abuse Counseling and Defense—advising and preparing legal opinions on matters involving federal and state anti-kickback laws, physician self-referral laws, and the False Claims Act and state insurance fraud laws; counseling on voluntary refund and self-disclosure protocols; and providing representation in civil and criminal government investigations and whistleblower (qui tam) actions
  • Business Transactions and Contracts—conducting due diligence and compliance reviews; advising on mergers, acquisitions, and joint ventures; advising on legal risk and achieving regulatory compliance consistent with business goals; and negotiating and drafting various transactional contracts related to professional and management services, employment and independent contractor services, equipment and space leases, marketing and sales arrangements, laboratory services, and software licensing and service arrangements  
  • Provider Billing and Collections—advising on Medicare and Medicaid enrollment; advising on private network and managed care contracting and out-of-network provider billing; counseling on reimbursement and overpayments; and providing representation in RAC, ZPIC, MAC, CMS, Medicaid, and private payor audits
  • Patient Privacy and Cyber-Security—advising on HIPAA Privacy and Security standards; conducting risk assessments; developing compliance policy and employee training programs; providing representation in complaint investigations and government audits; and counseling in privacy breach and remediation
  • Compliance Programs—counseling on federal and state regulatory compliance; conducting internal compliance reviews and risk audits and implementing remediation strategies; developing compliance manual and control protocol; and performing training and education programs

Representative Experience

  • Serves as outside counsel to national, regional, and local clinical, anatomic, molecular, genetic, and specialty laboratories on CLIA and state regulatory matters and on corporate, contractual, compliance, marketing, and reimbursement matters.
  • Serves as outside counsel to telehealth practice groups and management companies on federal and state regulatory matters related to professional licensure and standard of practice rules, government and private payor reimbursement, HIPAA rules and regulations, and state and federal pharmacy and laboratory regulations.
  • Represented private-equity and investment firms on regulatory and legal due diligence reviews and negotiating sales transaction documents in connection with acquisition of health care entities.
  • Represented multiple hospitals throughout the country in the sale of all or segments of their outreach laboratory programs to independent clinical laboratories.
  • Represented hospital laboratory in successfully responding to CMS notice of imposed principal sanctions for suspension of CLIA certificate and canceling Medicare payments.
  • Represented physician office laboratory in CAP revocation appeal and revising QM plan and operational restructure.
  • Counseled numerous clinical laboratories and anatomic pathologists on compliance with Medicare regulatory and compliance issues including CMS Medicare Part B collection and reporting requirements under PAMA.
  • Represented a physician group practice in a joint venture with an integrated health system under a mission support arrangement for hospitalist and outpatient specialty physician services.
  • Counseled a physician practice offering a blend of telehealth and concierge services in multiple states, on corporate formation and regulatory compliance with federal and state laws.
  • Represented numerous health care providers in appealing Medicare exclusion, revocation, and deactivation of billing privileges and implementing changes to corporate and regulatory compliance protocol.
  • Counseled an independent practice association (IPA) of nursing homes and community long-term care providers on managed care contract and antitrust issues.
  • Represented an accountable care organization (ACO) on corporate governance issues, provider participation arrangements, and the implementation of an integrated CMS compliance plan.

Mr. Dunham was named to the Upstate New York Rising Stars list (2015) and New York Metro Rising Stars list (2016) in the areas of Health Care and Business/Corporate.

Education

  • Albany Law School (J.D., cum laude, 2008)
    • Health Law Concentration
    • Albany Law Review, Senior Editor
  • State University of New York at Albany (B.A., magna cum laude, 2004)

Bar Admissions

  • New York
  • Texas

Court Admissions

  • U.S. District Court, Northern District of New York
  • U.S. District Court, Southern District of New York
  • U.S. District Court, Southern District of Texas
  • U.S. District Court, Western District of New York

Memberships

  • American Bar Association, Health Section
  • American Health Lawyers Association
  • New York State Bar Association, Health Law Section, E-Health and Information Systems Committee, Co-Chair