Health Care Regulatory

As Ben Franklin noted, “An ounce of prevention is worth a pound of cure.” Foley’s objective is to make certain that our health care clients are in the best position to avoid, or successfully defend, regulatory violations. We work with our clients to develop strategies to manage risks, prevent unwarranted scrutiny, comport with sentencing guidelines and government policies and considerations. 

Health Care Fraud and Abuse

Foley’s Healthcare attorneys—many of whom worked for the government or have dedicated their careers to preventing government pursuit—provide counsel, conduct investigations and defend civil and criminal matters involving federal and state Anti-Kickback statutes and physician self-referral laws (Stark). 

Foley’s deep experience with Fraud and Abuse and Stark allows us to work with our clients to design the most efficient provision of legal services, as our attorneys have often successfully handled similar Fraud and Abuse matters for other clients. Where defense or disclosure is necessary, our attorneys have positive relationships with many agents and attorneys, and do not need to start an investigation or propose remedies from scratch. Our attorneys also assist in establishing and evaluating compliance programs and can advise on important issues related to the False Claims Act and other compliance-related audits, investigations and initiatives, including Civil Monetary Penalty Laws.

Health Care Reimbursement

Foley offers one of the most sophisticated and broad reimbursement practices in the country dedicated to assisting clients with reimbursement, reimbursement litigation, and managed care contracting issues. Our practice has earned a reputation for identifying creative options to maximize revenue streams, responding to changes in the state or federal environment, and successfully challenging reimbursement cuts and audit disallowances.

The ability to anticipate, understand and respond to the complex and changing rules of the Medicare and Medicaid programs is crucial. Our attorneys have extensive industry and government experience in Medicare Parts A, B, C and D; Medicaid; commercial reimbursement; research payments; and the accompanying Fraud and Abuse issues associated with reimbursement rules. On a daily basis, we answer reimbursement questions from hospitals, facilities, institutions, suppliers, and providers relating to billing processes, enrollment, credentialing/licensing issues, claims and costs appeals, and related matters. We assist our clients in audit responses, both on the merits and on the procedural issues. 

Our attorneys provide sophisticated Medicaid and Medicare reimbursement appeal, settlement negotiation, and dispute resolution services, having handled many payment disputes on behalf of providers, suppliers and payors. We keep abreast of new developments in the Medicare and Medicaid arena because of our daily national work, our leadership roles in health law professional associations, and our tracking of trends in the innovative work we do for our clients across the industry and across the country. An area of significant reimbursement activity since the passage of PPACA, we routinely advise clients on dealing with identified overpayments. We are an industry thought leader on this issue, and offer clients strategic insight and value beyond a simple reading of the statute. 

Health Care Compliance and Operations

We counsel clients on compliance issues, including the assessment of appropriate infrastructure, development of written policies and procedures, development of compliance training, and the design and implementation of monitoring and reporting systems.  Foley works to develop compliance structures and strategies to manage risks, prevent unwarranted scrutiny and comport with sentencing guidelines for effective compliance programs and government policies and considerations. In addition to providing Fraud and Abuse and compliance-related counsel and advice, Foley conducts internal investigations regarding compliance with federal and state Anti-Kickback statutes and physician self-referral laws and make regular appearances before administrative agencies at the federal and state level.  We work collaboratively with the white-collar defense team when matters require litigation.

Foley provides advice and counsel on health care compliance matters encompassing virtually every aspect of the industry, including Medicare and Medicaid regulatory compliance, hospital and physician payment and reimbursement, HIPAA privacy and confidentiality issues, including those related to the completion, retention, storage and organization of medical records, Emergency Medical Treatment and Active Labor Act (EMTALA) issues, licensing and medical staff/physician contracting. 

In addition to our core Health Care Law attorneys, the Regulatory group is enhanced by our 150-member Health Care Industry Team. To learn more, click here.

Insights

Let’s Talk Compliance | Provider Relief Fund: Reporting Requirements and Compliance Concerns

16 July 2021
Webinar