Regulatory & Compliance

Maintaining compliance with federal and state health care regulations can be challenging. We help clients comply with the evolving regulations by developing, implementing, and refining the corporate compliance programs necessary to keep their systems running smoothly and in full compliance. For organizations expanding into additional states, we provide insights and guidance into each state’s legal requirements, including the corporate practice of medicine and fee splitting.

Regulatory Compliance: We maintain strong relationships with state and federal regulators and have an in-depth understanding of the compliance survey process. We put this knowledge to work for our clients, guiding them through the steps necessary to address client professionals’ licensing and other regulatory compliance matters.

As it relates to compliance matters for the larger operation of client health care businesses, we also provide operational guidance, keeping an eye on the big picture as well as the smallest deadline.

Health care clients turn to us for counsel relating to:

Certificate of Need
Facility and professional licensure and certification
Medicare and Medicaid certification – provider-based status, distinct part units, hospitals within hospitals and regulatory surveys

Emergency Medical Treatment and Active Labor Act (EMTALA) and other organizational policy and accreditation issues relating to emergency services

Accreditation – The Joint Commission, AOA, and other national accreditation agencies

Fraud & Abuse: A growing issue within the health care industry, fraud and abuse claims and compliance issues can be daunting. We provide complete legal support for health care providers in this area, including advising on:

State and federal anti-kickback and self-referral laws (Stark Laws)
False claims
Physician recruitment and practice development
Overpayments, repayments, and self-disclosures

We will work closely with the client to develop strategic legal plans and draft legal opinions and all related documents and agreements to help clients maintain compliance and avoid future claims. We also assist with working with state and federal regulators to resolve issues.

Medicare / Medicaid Compliance & Counseling: We regularly advise clients in their interactions with governmental payors and fiscal intermediaries and have extensive experience assisting with reimbursement issues relating to corporate operations, including:

Survey and certification issues
Provider-based status
Distinct part units
Hospitals within hospitals
Successor liability and change of ownership
General billing and documentation issues, such as cost report issues, appropriate clinical documentation, compliance with billing requirements
Billing audits, including recoupments, administrative review, and judicial appeals of claim denials
Provider enrollment issues

Medical Staff & Professional Rights: Managing the rights of professional staff and dealing with medical staff issues are important tasks for health care organizations. Clients turn to us for assistance in these situations as well as in matters addressing credentialing and retention issues, such as:

Recommending corrective actions for disruptive or impaired physicians
Participating in peer review and fair hearing procedures
Preventing negligent credentialing, negligent reference, or inappropriate economic credentialing claims
Structuring exclusive provider arrangements
Providing guidance on reporting requirements for state licensing boards and the National Practitioner Data Bank
Drafting policies and medical staff bylaws, rules, regulations and policies

We have extensive experience structuring medical staff committees as peer review committees and advising clients on confidentiality and discoverability of information used in peer review, quality review, and patient safety activities. We have also represented physicians, nurses, physical therapists, and other health care professionals in professional disciplinary actions with state licensing agencies.

Investigations: We provide practical, proactive advice in internal compliance investigations, establishing protocols when needed, assisting in the interview process, and documenting the investigation from start to finish. In the instance of an external investigation, we also represent health care clients throughout the process, providing counsel when an investigation is anticipated, representing the organization through interviews when possible, and guiding the organizational response – both internally and with the public. We can also assist with self-reporting and self-disclosure measures.

Maintaining compliance with federal and state health care regulations can be challenging. We help clients comply with the evolving regulations by developing, implementing, and refining the corporate compliance programs necessary to keep their systems running smoothly and in full compliance. For organizations expanding into additional states, we provide insights and guidance into each state’s legal requirements, including the corporate practice of medicine and fee splitting.

Regulatory Compliance: We maintain strong relationships with state and federal regulators and have an in-depth understanding of the compliance survey process. We put this knowledge to work for our clients, guiding them through the steps necessary to address client professionals’ licensing and other regulatory compliance matters.

As it relates to compliance matters for the larger operation of client health care businesses, we also provide operational guidance, keeping an eye on the big picture as well as the smallest deadline.

Health care clients turn to us for counsel relating to:

Certificate of Need
Facility and professional licensure and certification
Medicare and Medicaid certification – provider-based status, distinct part units, hospitals within hospitals and regulatory surveys

Emergency Medical Treatment and Active Labor Act (EMTALA) and other organizational policy and accreditation issues relating to emergency services

Accreditation – The Joint Commission, AOA, and other national accreditation agencies

Fraud & Abuse: A growing issue within the health care industry, fraud and abuse claims and compliance issues can be daunting. We provide complete legal support for health care providers in this area, including advising on:

State and federal anti-kickback and self-referral laws (Stark Laws)
False claims
Physician recruitment and practice development
Overpayments, repayments, and self-disclosures

We will work closely with the client to develop strategic legal plans and draft legal opinions and all related documents and agreements to help clients maintain compliance and avoid future claims. We also assist with working with state and federal regulators to resolve issues.

Medicare / Medicaid Compliance & Counseling: We regularly advise clients in their interactions with governmental payors and fiscal intermediaries and have extensive experience assisting with reimbursement issues relating to corporate operations, including:

Survey and certification issues
Provider-based status
Distinct part units
Hospitals within hospitals
Successor liability and change of ownership
General billing and documentation issues, such as cost report issues, appropriate clinical documentation, compliance with billing requirements
Billing audits, including recoupments, administrative review, and judicial appeals of claim denials
Provider enrollment issues

Medical Staff & Professional Rights: Managing the rights of professional staff and dealing with medical staff issues are important tasks for health care organizations. Clients turn to us for assistance in these situations as well as in matters addressing credentialing and retention issues, such as:

Recommending corrective actions for disruptive or impaired physicians
Participating in peer review and fair hearing procedures
Preventing negligent credentialing, negligent reference, or inappropriate economic credentialing claims
Structuring exclusive provider arrangements
Providing guidance on reporting requirements for state licensing boards and the National Practitioner Data Bank
Drafting policies and medical staff bylaws, rules, regulations and policies

We have extensive experience structuring medical staff committees as peer review committees and advising clients on confidentiality and discoverability of information used in peer review, quality review, and patient safety activities. We have also represented physicians, nurses, physical therapists, and other health care professionals in professional disciplinary actions with state licensing agencies.

Investigations: We provide practical, proactive advice in internal compliance investigations, establishing protocols when needed, assisting in the interview process, and documenting the investigation from start to finish. In the instance of an external investigation, we also represent health care clients throughout the process, providing counsel when an investigation is anticipated, representing the organization through interviews when possible, and guiding the organizational response – both internally and with the public. We can also assist with self-reporting and self-disclosure measures.