Overview
For physicians, hospitals, managed care organizations, and other health care providers, every aspect of service delivery is closely scrutinized for fraud and abuse.
In a space where simple mistakes can trigger onerous enforcement actions, our Fraud and Abuse Compliance Counseling and Defense lawyers work with providers to mitigate legal risk and defend them in government investigations.
Staying in Front of Compliance Issues
The best way to handle government inquiries is to avoid triggering them in the first place. Our clients count on us to structure compliance strategies that comport with their operational needs and risk tolerance. We scrutinize their processes and procedures to stay in front of any issues concerning the statutes—the Stark Law, the federal Anti-Kickback Statute, the Eliminating Kickbacks in Recovery Act, the False Claims Act (FCA), etc.—that are most likely to see enforcement. Often, our clients will sense a possible problem in advance of any government inquiry and will ask us to investigate and—depending on our findings—recommend corrective action.
Defending in Enforcement Actions
Government investigations can be lengthy, expensive, and disruptive to business operations. Our attorneys are the first ones called when a subpoena arrives, and our clients rely on us to respond to any investigation with an eye toward narrowing its scope or making it go away. Our deep knowledge of provider relationships in all health care categories—as well as their billing and reimbursement practices—informs our response and gives us strong arguments to offer in defense.
Understanding the Agencies
Whether we’re preventing government investigations or defending them, most of the issues that come up are ones we’ve seen many times before. Our attorneys have a deep understanding of federal, state, and local agencies and how best to meet their expectations. This invariably works to our clients’ advantage when responding to investigations and negotiating compliance agreements.
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Experience
- Protected a nonprofit health care provider from fraud and abuse liability after it entered into a joint venture with another hospital and local physicians. Due to a consulting error, distributions were made before the required assets were transferred to the joint venture. We re-characterized certain distributions in a manner that was permissible and eliminated the need for a voluntary disclosure to the government or dissolution of the joint venture.
- Negotiated a favorable result for a private investment manager in a matter before the Office of Inspector General (OIG) in which OIG concluded that a corporate integrity agreement (CIA) was not necessary with respect to a qui tam relator’s allegations that a health care company in the client’s portfolio violated the FCA by engaging in “swapping” arrangements.
- Conducted an internal investigation of an overpayment caused by a regional health care entity client’s overreliance on an artificial intelligence software program. Our findings led to a disclosure to a government agency and corrective action.
- Successfully defended a health care provider against an FCA lawsuit asserting that our client was part of a scheme to allegedly submit false claims for health care costs reimbursed by the federal Medicare, Medicaid, and TRICARE programs. We convinced the court that the qui tam relator failed to allege sufficient details proving that the claimed scheme led to our client submitting false claims to the federal government.
- Conducted an internal investigation into a whistleblower complaint against a Florida health system client. The complaint alleged possible legal violations by the company’s interim system CEO that were also potential violations of the client’s obligations under a CIA. After investigating the allegations, including reviewing documents and conducting interviews, we prepared a notification of the reportable event to OIG concerning the interim system CEO’s probable violations of the Anti-Kickback Statute. Our investigative findings led to the interim system CEO’s termination.
- Obtained a complete dismissal of a Medicare Advantage risk adjustment case against our health care client without any finding or admission of liability in exchange for a contribution of just 5 percent of the settlement amount. The cost to settle this case was a fraction of the costs the client would have incurred in litigating the case to a conclusion.
- Secured the dismissal of a federal criminal indictment in a federal court in the South charging our client—the former CEO of a durable medical equipment supplier—and several co-defendants with violating the Anti-Kickback Statute. The dismissal of a federal criminal case is unusual, even more so in this case, because the government sought dismissal in response to our defense motion arguing improper venue.
Contacts
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Media
Events
Past Events
- October 26, 2022
Insights
Insights
- Blogs
What to Do If the Government Knocks on Your Company’s Door … or Breaks It Down – Speaking of Litigation Podcast
28 minute read - Firm AnnouncementsEpstein Becker Green Announces 2024 Promotions6 minute read
- PublicationsRecent Developments in Federal and State Fraud and Abuse Investigations2 minute read
- Firm Announcements
Elizabeth Scarola Named to the 2023 Florida Rising Stars List
6 minute read - Media CoverageGeorge Breen Quoted in “Conservative Justices Cast Constitutional Cloud Over False Claims Act Decision”7 minute read
- Publications
3 Abortion Enforcement Takeaways 1 Year After Dobbs
2 minute read - Firm Announcements
Jessika Tuazon Named to the 2023 Southern California Rising Stars List
6 minute read - Firm Announcements
Epstein Becker Green Recognized Among Top 10 Largest Health Care Law Firms by Modern Healthcare
2 minute read - PublicationsFCA Enforcement and Litigation Trends to Watch3 minute read
- Media CoverageLisa Pierce Reisz Featured in “People on the Move”1 minute read
- Media CoverageLisa Pierce Reisz Featured in “Wake Up Call: Laterals, Moves, In-House”1 minute read
- Media CoverageLisa Pierce Reisz Featured in “Epstein Becker Brings On Health Care Atty in Ohio”2 minute read
- Firm AnnouncementsHealth Care Attorney Lisa Pierce Reisz Joins Epstein Becker Green in Columbus4 minute read
- Media CoverageGeorge Breen Quoted in “Justices Ignite FCA Debate: Fairness vs. 'Invitation to Fraud'”3 minute read
- Media CoverageJayme Matchinski Featured in “Health Hires: Epstein Becker Green”2 minute read
- Media Coverage
Jayme Matchinski Featured in the Chicago Daily Law Bulletin’s “People” Column
1 minute read - Media CoverageOffice Snapshot: Epstein Becker Green's New Nashville Outpost3 minute read
- Media CoverageElizabeth Scarola Featured in “People on the Move”1 minute read
- Media CoverageJayme Matchinski Featured in “Laterals, Moves, In-House”1 minute read
- Firm AnnouncementsHealth Care Attorney Jayme R. Matchinski Joins Epstein Becker Green in Chicago3 minute read
- PublicationsCurrent Trends in Federal and State Fraud and Abuse Investigations1 minute read
- Firm AnnouncementsEpstein Becker Green Announces 2023 PromotionsOctober 28, 20225 minute read
- PublicationsHealth Care Fraud Law: A 50 State Survey2 minute read
- Media CoverageArena District Gains National Law Firm Tenant: Epstein Becker Green Moves into New Office Space in Columbus, Ohio ...2 minute read
- Firm AnnouncementsEpstein Becker Green Expands Columbus Office in New Arena District Location3 minute read
- Media CoverageAmy Lerman Quoted in “Use the OIG’s Data Brief on Telehealth to Boost Your Compliance Efforts”2 minute read
- Media CoverageAmy Lerman Quoted in “Don’t Let OIG Fraud Alert Disrupt Your Practice’s Telehealth Program”2 minute read
- Media CoverageAmy Lerman Quoted in “Telemedicine or Telescam? Heed the Warnings in the Latest Special Fraud Alert”2 minute read
- Firm AnnouncementsLynn Shapiro Snyder Serves on the Nashville Health Care Council’s Board of Directors2 minute read
- Media CoverageLynn Shapiro Snyder Continues Service on Nashville Health Care Council’s Board of Directors2 minute read
- PublicationsFTC’s PBM Study Signals Broader Federal Scrutiny of the Prescription Drug Sector23 minute read
- Firm AnnouncementsEpstein Becker Green’s Lasting Support of AHLA Recognized in 2022 Top Honors and New Leadership Positions2 minute read
- Firm Announcements
Elizabeth Scarola Named to the 2022 Florida Rising Stars List
6 minute read - Firm Announcements
Jessika Tuazon Named to the 2022 Southern California Rising Stars List
5 minute read - Media CoverageLisa Gora Featured in “Epstein Becker Taps Cannabis, Health Care Pro”2 minute read
- Media CoverageLisa Gora Featured in “Wake Up Call: Laterals, Moves, In-House”1 minute read
- Firm AnnouncementsHealth Care Attorney Lisa Gora Joins Epstein Becker Green in Newark5 minute read
- Firm Announcements
Thirteen Attorneys Named to the 2022 Washington, DC, Super Lawyers and Rising Stars Lists
5 minute read - Firm AnnouncementsEpstein Becker Green Again Recognized as One of the Largest Health Care Law Firms2 minute read
- Media Coverage
Epstein Becker Green Attorneys Elected to Law360’s 2022 Editorial Advisory Boards
4 minute read - PublicationsFCA Trends to Watch for Health, Life Sciences Cos.3 minute read
- PublicationsDOJ's 2021 Healthcare Fraud Enforcement Action (or Takedown): New Name, Same Priorities2 minute read
- Media Coverage
Glenn Prives Featured in Bloomberg Law “Wake Up Call: Laterals, Moves, In-House”
1 minute read - Media CoverageNJBiz Features Glenn Prives in “Health Care Attorney Joins Epstein Becker Green”2 minute read
- Media CoverageEpstein Becker Green Welcomes Glenn Prives, Health Care and Corporate Attorney3 minute read
- Media CoverageSarah M. Hall Quoted in “The Insys Case Made History. Why an Exec's Appeal May Not”3 minute read
- Firm AnnouncementsHealth Care & Corporate Law Attorney Glenn P. Prives Joins Epstein Becker Green4 minute read
- PublicationsOSTP Releases Highly Anticipated Guidance on National Security Strategy for Federally Funded Research6 minute read
- Firm Announcements
Three Attorneys Named to the 2022 Ohio Super Lawyers and Rising Stars Lists
2 minute read - Firm Announcements
Richard W. Westling Named to the 2021 Mid-South Super Lawyers List
8 minute read