Physicians, hospitals, managed care organizations, and many other providers of health services face significant regulatory hurdles as payors attempt to combat health care fraud and abuse. In addition, the efforts by payors to reduce, or at least contain, costs have challenged health care providers to develop new professional relationships and organizational structures. However, many of these new relationships and structures must be reviewed carefully to ensure that a wide array of federal and state laws governing fraud and abuse are not violated.
Epstein Becker Green has counseled health care organizations throughout the country in managing the risks of fraud and abuse, and firm attorneys are authors of respected texts on this complex subject. The rules governing fraud and abuse continue to evolve as new laws are passed, new regulations are promulgated, new cases are tested in the courts, and new government settlements take place. All of these activities require ongoing reviews of new and existing contractual and financial relationships.
Epstein Becker Green provides complete legal support for health care organizations in connection with fraud and abuse compliance, state and federal anti-kickback, self-referral, unfair trade practices, false claims, and secondary payor issues, including:
- Legal audits conducted of existing contracts and financial relationships
- The development of strategic legal plans for acquisitions of facilities and practices
- The preparation of legal opinions regarding new financial relationships
- Representation of clients that are subjects of preliminary inquiries and formal government investigations
- The development of corporate compliance plans
- The preparation of investment documents, leases, services contracts, and employment arrangements subject to fraud and abuse laws
- Due diligence reviews for buyers and sellers of health care companies
- Interpretation of anti-kickback and self-referral laws at the federal and state levels
- Reviews of new financial offerings
- Representation before federal and state regulatory agencies
- Reviews of policies and procedures of billing operations
- Client representation in litigation related to fraud and abuse laws, such as false claims, qui tam cases, unfair trade practices, and other possible enforcement activities
- The preparation and health regulatory review of offering memoranda and prospectus