For physicians, hospitals, managed care organizations, and many other providers of health care services, every aspect of service delivery is closely scrutinized for fraud and abuse. In an environment where simple mistakes can trigger onerous enforcement actions, our Fraud and Abuse Counseling and Defense lawyers work with providers to mitigate compliance 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 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 towards 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 the 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.