Handling the complex legal and regulatory issues unique to health care.
The complex, heavily regulated nature of the health care industry requires special focus and attention in order to avoid undue legal and financial risk. Additionally, the recent increase in governmental enforcement efforts has resulted in particularly challenging times for health care providers.
While financial pressures demand innovative business strategies, the regulated environment of health care presents a challenge that is full of a high degree of legal uncertainty. Buchanan's Compliance Group is made up of attorneys with years of experience in handling the complex legal and regulatory issues unique to health care. Our experience includes the representation of hospitals, health care systems, long-term care facilities, pharmaceutical companies, home health agencies, and physician groups in a wide variety of issues and matters.
Many of our attorneys have served as general counsel for health care-related entities. We are sensitive to the strategic and operational issues confronting health care providers. While our focus is proactive and designed to avoid problems before they occur, we also have significant experience in managing the legal process once difficulties arise.
Examples of the types of services we offer include:
Advice & Counsel
- Analysis on the Stark, Anti-Kickback, False Claims Acts and similar Federal and state laws
- Review regarding compliance with safe harbor regulations
- Preparation of advisory opinion requests for submission to the OIG
- Counsel in employment separation situations in regards to whistleblower and related concerns
- Reimbursement advice concerning coverage and other reimbursement issues
- Counsel regarding detailed reimbursement rules including rules related to assignment, "incident to" billing, and related parties
- Compliance counseling concerning the Prescription Drug Marketing Act
- Advice regarding compliance with rules regulating medical research
- Representation regarding conflicts of interest and other corporate misbehavior
- Advice in structuring transactions in order to avoid regulatory concerns
- Due diligence review of regulatory and reimbursement issues within the context of mergers, acquisitions and similar transactions
- Negotiation and drafting of contracts and other documents in situations were a sensitivity to fraud-related issues is necessary
- Assistance with physician recruitment and retention strategies
- Internal investigations of potential noncompliance with the laws and regulations impacting health care providers
- Representation of health care providers in qui tam actions and federal and state investigations
- Advice in responding to subpoenas, warrants, civil investigative demands, and similar governmental requests
- Negotiation of corporate integrity agreements (CIA) and advice regarding compliance with CIAs
Compliance Program Design and Operation
- Design and implementation of corporate compliance programs
- Counsel regarding self-disclosure of noncompliance to the fiscal intermediary, OIG or state agency
- Assistance in audits of billing, coding and other reimbursement practices
- Compliance educational sessions for board members, employees and medical staffs
Fraud and Abuse
Clients are under increased pressure to guard against allegations of Medicare and Medicaid fraud and abuse. Our attorneys have experience in dealing with questions under federal/state false claims, Stark and anti-kickback laws, as well as the many other statutes and regulations governing them. We assist clients with:
- Corporate compliance programs.
- Medicare/Medicaid audits.
- Grand jury, OIG and Medicaid fraud unit investigations.
- Litigation, negotiation and settlement of government claims.