HEALTH CARE FRAUD & ABUSE

As rules governing fraud and abuse continue to change, hospitals, physicians, and other health care provider clients face complex and ever-evolving federal and state regulations. What was once considered a simple billing error for health care providers is now pursued as alleged fraud and abuse. All of these regulatory hurdles and activities require clients to have ongoing reviews of financial and contractual relationships, and seasoned counsel who can guide them.

Nixon Peabody’s Health Services practice group has extensive experience counseling health care providers on compliance with fraud and abuse laws and defending health care providers in connection with the investigation and prosecution of health care fraud. Our in-depth understanding of the types of transactions likely to attract the attention of the Inspector General allows us to use creative solutions for our clients’ problems. We assist our clients in structuring complex transactions and relationships within the bounds of the law, while minimizing the risk that their business practices will be challenged by regulatory agencies.

Our team routinely counsels clients on compliance with federal and state statutes and regulations, including Medicare and Medicaid anti-kickback laws, Stark and related self-referral prohibitions, the False Claims Act, safe harbor regulations, secondary payor issues, and a myriad of other statutes establishing potential criminal and civil penalties.

In addition, our attorneys perform fraud and abuse audits for our clients with existing contracts and financial relationships. We also assist in the development of corporate compliance programs for our clients, and negotiate and monitor corporate integrity agreements. Our goal as counsel is to promote early identification of such activity when it occurs, prevent illegal activity, and minimize penalties.