Overview
Attorney Anjali Downs’ commanding knowledge of the False Claims Act, Anti-Kickback Statute, and Stark Law safeguards health care clients’ products, services, and ensures operational success.
Clients, which range from providers to device manufacturers and ambulatory centers, depend on her in-depth understanding of the fraud and abuse laws and what triggers government authorities to take exception.
Whether ensuring a tech company’s innovation launches smoothly or facilitating innovative arrangements among and between referral sources or defending health systems against whistleblower claims, Anjali has the skills and experience necessary to effectively handle the diverse legal needs of her clients.
During investigations, Anjali is particularly effective in persuading government regulators on issues where official guidance is scant and/or evolving, such as in substance use disorder treatment. Her skillful, novel defenses inform regulators and have reduced the threat of program exclusion, costly settlements, and other steep penalties. Anjali credits her training in public health community education with developing her empathetic style—just one reason behind the long-term relationships clients build with her.
As regulatory counsel, which is greatly enhanced by a strong defensive game, Anjali aligns clients’ risk tolerance with commercial opportunities to create a path forward. As value-based care expands, Anjali is preparing clients to meet related challenges on fraud and abuse laws and the interactions by and between health care referral sources.
Anjali is the Managing Shareholder of Epstein Becker Green’s Washington, DC, office.
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Focus Areas
Services
- Behavioral Health
- Corporate Compliance Program Development, Implementation, and Effectiveness
- Federal and State False Claims Act (Including Qui Tam)
- Fraud and Abuse Compliance Counseling and Defense
- Government and Commercial Coding, Coverage, and Payment
- Health Care
- Health Care and Life Sciences Investigations and Enforcement
- Stark and Self-Referral Laws
- White Collar Defense and Internal Investigations
Experience
- Negotiated a settlement for a financially distressed pain management company and ambulatory surgery center to bring a five-year government investigation to closure. Working at the request of the primary lenders, Anjali structured an ability-to-pay settlement with written cold comfort that opened up the possibility of a transaction whereby the secured lender could become majority owner of the company.
- Represented a provider in a fraud inquiry by a private insurer serving as a third-party administrator/contractor for a state Medicaid program. By developing a strategy focused on the ambiguity of guidance by the insurer and by focusing on the proactive actions of the provider, Anjali was able to structure a settlement that was significantly reduced from the insurer’s initial settlement demand.
- Advised a multistate oncology services network in its implementation of its Corporate Integrity Agreement.
- Developed a comprehensive compliance plan for a company utilizing artificial intelligence in billing and coding.
- Counseled a national non-traditional health care company as it navigated the fraud and abuse regulatory scheme to become a provider in the health care delivery system.
- Conducted an internal investigation and prepared a self-disclosure on behalf of a substance use disorder provider related to lack of documentation for services provided.
- Served as an Independent Review Organization (IRO) reviewing Focus Arrangements for a hospital system during a five-year Corporate Integrity Agreement.
Recognition
- Chambers USA: America’s Leading Lawyers for Business: District of Columbia—Healthcare, "Leader in Their Field" (2021 to 2024)
- The Legal 500 United States, Healthcare: Service Providers (2024)
- Washington DC Rising Stars: Health Care (2017 to 2019)
Credentials
Education
- University of Maryland School of Law (J.D., cum laude, 2008)
- Article Editor, Journal of health Care Law and Policy
- University of Maryland (M.P.H., 2002)
- University of Maryland (B.A., 1999)
Bar Admissions
- District of Columbia
- Maryland
Media
Events
Past Events
Insights
Insights
- Firm Announcements
Epstein Becker Green Receives National Recognition and Top Rankings in the 2024 Edition of Legal 500
3 minute read - Firm Announcements
Epstein Becker Green Honored for Exceptional Performance in Key Practice Areas by Chambers USA 2024
5 minute read - Firm Announcements
Epstein Becker Green Recognized for Focused Excellence Across Core Practice Areas in Chambers USA 2023
5 minute read - Firm AnnouncementsChambers USA 2022 Recognizes Epstein Becker Green's Focused Excellence in Core Practice Areas: Distinguished in ...4 minute read
- PublicationsBest Practices for Mental Health Parity: Considerations for ImplementationAugust 20213 minute read
- PublicationsU.S. Department of Labor Settles Unprecedented Lawsuit Against United Healthcare for Violations of the Mental Health ...12 minute read
- Firm Announcements
Epstein Becker Green’s Focused Excellence Lauded by Chambers USA in 2021 Edition of Leading Law Firms and Attorneys ...
3 minute read - PublicationsOIG and CMS Issue Long-Awaited Value-Based Safe Harbors and Exceptions; Now What?2 minute read
- BlogsBuilding Compliance Programs for AI Tools3 minute read
- PublicationsAre We There Yet? OIG and CMS Issue Long-Awaited Final Rules Aimed at Promoting Innovative Value-Based Care Models and ...3 minute read
- PublicationsStark Law Updates Aimed at Advancing the Transition to Value-Based Care: CMS Issues a Final Rule Creating New Exceptions for ...26 minute read
- PublicationsOIG Issues a Final Rule Designed to Advance the Transition to Value-Based Care and Modernize the Regulatory Framework ...39 minute read
- PublicationsHHS's Efforts to Reduce Prescription Drug Prices and Transition to Value-Based Care – Part 1: CMS and OIG Issue a Series of ...15 minute read
- Firm AnnouncementsEpstein Becker Green’s Long-Standing History and Ongoing Relationship with AHLA Recognized in 2020 Top Honors List ...5 minute read
- PublicationsINSIGHT: Health-Care Transactions Will Pick Back Up After Virus3 minute read
- PublicationsINSIGHT: Fake Cures and Test Kits—Scammers Target Health Care4 minute read
- PublicationsINSIGHT: Managing Health-Care Workers During Coronavirus3 minute read
- Media CoverageBloomberg Law "Weekend Read” Features Epstein Becker Green Insights on Health-Care Coverage and Reimbursement Amid ...2 minute read
- PublicationsINSIGHT: Health-Care Coverage and Reimbursement Amid Coronavirus2 minute read
- Media CoverageBloomberg Law "Weekend Read" Features Epstein Becker Green Insights on Coronavirus Telehealth Coverage and Privacy Under ...2 minute read
- PublicationsINSIGHTS: Waived Medicare Telehealth Copayments Leave Unanswered Questions2 minute read
- PublicationsINSIGHT: Key Medicare Telehealth, HIPAA Changes During Coronavirus Pandemic2 minute read
- BlogsSecretary Azar Urges Governors to Take Action to Lift Restrictions to Extend the Capacity of the Health Care Workforce ...3 minute read
- PublicationsHHS's Regulatory Sprint to Coordinated Care – Part 3: CMS Proposes Expansive Set of Changes to Stark Regulations ...60 minute read
- PublicationsHHS’s Regulatory Sprint to Coordinated Care – Part 2: OIG Issues Long-Awaited Proposed Rules34 minute read
- PublicationsHHS's Regulatory Sprint to Coordinated Care - Part 1: CMS and OIG Issue Long-Awaited Proposed Rules10 minute read
- Media CoverageAnjali Downs Quoted in "HHS Floats Stark/Anti-Kickback Revisions to Support Value-Based Care"2 minute read
- BlogsArrangements, Exceptions, and Modifications - OIG and CMS Challenge the Status Quo3 minute read
- BlogsDoes It Pay to Cooperate? Department of Justice Releases New Cooperation Credit Guidance for False Claims Act Targets ...2 minute read
- Firm Announcements
Sixteen Epstein Becker Green Attorneys in Washington, DC, Named to 2019 Super Lawyers and Rising Stars Lists
6 minute read - Media CoverageAnjali Downs Quoted in "Evolution of Healthcare Industry Poses New and Ongoing Compliance Risks in 2019"4 minute read
- PublicationsINSIGHT: Five Health-Care Fraud and Abuse Trends to Watch2 minute read
- PublicationsResponse to RFIs: EBG Submits Comments to CMS on Stark Law Reforms and Is Preparing Comments to OIG on Anti-Kickback Statute ...8 minute read
- PublicationsCMS Request for Information: Reforming the Stark Law to Facilitate the Transformation to Value-Based Care5 minute read
- Firm Announcements
Seventeen Epstein Becker Green Attorneys Named to 2018 Washington DC Super Lawyers and Rising Stars Lists
5 minute read - PublicationsRecent DOJ and HHS-OIG Guidance Keep Compliance and Individual Accountability in Cross-Hairs2 minute read
- Firm Announcements
Sixteen Epstein Becker Green Attorneys Named to 2017 Washington DC Super Lawyers and Rising Stars Lists
5 minute read - PublicationsThe Case for and Against Minimum Director Independence Requirements2 minute read
- PublicationsMinimum Director Independence Requirements: The Next Trend in Hospital Governance?2 minute read
- Media CoverageAnjali Downs, Joshua Freemire, Jungmin Choi Recognized in "Law360 Names Attys Who Moved Up the Firm Ranks in Q1" ...1 minute read
- PublicationsCMS Issues Long-Awaited Rule Regarding Reporting and Returning Overpayments16 minute read
- Media Coverage
Anjali Downs Featured in Washington Business Journal "People on the Move" Column
1 minute read - Firm AnnouncementsEpstein Becker Green Announces 2016 Promotions4 minute read
- PublicationsOIG Proposes New Safe Harbors to the Anti-Kickback Statute and New Exceptions to the Two Civil Monetary Penalty Provisions ...31 minute read
- PublicationsOIG Supplemental Advisory Bulletin on Patient Assistance Programs Leaves Open Questions for High-Cost Breakthrough Drugs ...10 minute read
- Publications
The OIG's Updated Self-Disclosure Protocol: Greater Transparency, but Proceed with Caution, as appeared in Bloomberg ...
1 minute read - PublicationsOIG Unveils Updated Self-Disclosure Protocol19 minute read
- Firm Announcements
Epstein Becker Green Attorneys Author AHLA Bestselling Book: Legal Issues in Healthcare Fraud and Abuse: Navigating the ...
4 minute read - Publications
Practical Considerations: A Guide to Voluntary Self-Disclosure, as appeared in Compliance Today
1 minute read - PublicationsHEALTH REFORM: The Clock Is Ticking: CMS Issues a Proposed Rule on Reporting and Returning Overpayments15 minute read