Arent Fox is an industry leader on the numerous complex legal requirements that apply to relationships among providers, suppliers and other companies doing business in the health care industry, as well as their relationships with physicians. Our lawyers are nationally recognized for their expertise and experience counseling clients on the Anti-Kickback Statute, the Stark Law, the False Claims Act, the laws relating to beneficiary inducement prohibitions, civil monetary penalties, exclusion, fee splitting, the corporate practice of medicine, and their State counterparts. In addition, Arent Fox attorneys have deep experience with the myriad Medicare and Medicaid reimbursement issues that often form the basis for fraud and abuse enforcement.
We have advised hospitals and health systems (including specialty hospitals such as LTACHs, children’s hospitals and AMCs), nursing homes, hospices, home care agencies, medical device and pharmaceutical manufacturers, ambulatory surgery centers, clinical laboratories, therapy companies, and a broad range of other health care providers and suppliers, as well as clinical researchers and health care practitioners.
Our team is at the forefront of health care compliance and includes professionals with decades of experience counseling clients on complex regulatory matters, including former HHS and OIG counsel, certified professional coders and clinicians as well as nationally recognized experts in the fraud and abuse laws and Medicare requirements.
Our practice includes advising clients on the development and implementation of strategies to minimize exposure under the fraud and abuse laws; working proactively with management, employees and Board members to develop effective compliance programs, policies and training tailored to the specific regulatory environment. We help conduct internal audits to evaluate specific regulatory issues as well as overall compliance program effectiveness. Arent Fox attorneys frequently assist clients in determining when a compliance failure creates overpayment liability, assessing the scope of potential liability and making self-disclosures to the appropriate government entity.
Another key part of our practice involves guiding clients through government-initiated audits, limiting the audit’s scope where possible, and preempting unnecessary disputes and litigation. Where our clients have been unable to avoid litigation, we have won and successfully settled many major cases.
We have experience defending matters related to:
Billing and coding errors (or alleged fraud) related to Medicare and Medicaid payment and coverage requirements (on issues ranging from inpatient admission/observation status to the DRG payment window, appropriate level of supervision, use of modifiers, and services furnished by excluded providers)
Government medical reviews, audits and investigations initiated by agencies such as the Department of Justice (DOJ), the Office of Inspector General of the Department of Health and Human Services (OIG), the Medicare Administrative Contractors (MACs), the Recovery Audit Contractors (RACs), the Zone Program Integrity Contractors (ZPICs), and Medicaid Fraud Control Units (MFCUs)
Challenging overpayment determinations (especially by RACs) through administrative appeals
Clinical research fraud
Challenging billing privilege suspension, revocation or program enrollment termination.
Our attorneys understand the collateral consequences that can result from fraud and abuse investigations, and we help clients avoid or defend against exclusion, suspension, or debarment.