Health Care Compliance



We merge our transactional practice with our nationally recognized governmental investigation practice to prevent compliance violations and investigate and defend compliance lapses.

Our Approach

Health care fraud has become one of the top priorities of our current administration.

Our attorneys establish, implement and monitor compliance programs that prevent, detect and correct practices that fail to comply with the complex fraud and abuse laws governing the provision and billing of health care services. And if we identify violations, we quickly prevent further illegal activity and minimize penalties.

An effective compliance program is key to the success of a health care provider’s operations and business ventures. We help to prevent violations of Medicare and Medicaid anti-kickback laws, Stark laws and related self-referral prohibitions, the False Claims Act and other laws presenting risks for potential criminal and civil liability.

Additionally, we counsel and defend clients in connection with investigations and prosecutions of health care fraud allegations by both federal and state entities. We work on many False Claims Act-driven government investigations, including:

  • Emergency room E&M coding initiatives
  • Laboratory unbundling initiatives
  • Pneumonia upcoding reviews
  • Laboratory investigations
  • Investigational devices issues
  • PATH audits and investigations
  • DRG 72-Hour Window claims

When necessary, we also negotiate and fulfill the obligations under corporate integrity agreements.

We work with

  • Hospitals and health systems
  • Medical device manufacturers
  • Physicians
  • Other health care providers

Scripps cyberattack highlights patient safety risks during breaches

Modern Healthcare | May 14, 2021

In this article on the recent cyberattack on Scripps Health, which disrupted the San Diego-based health system’s patient portal and email systems, Chicago Health Care partner Valerie Montague is quoted on HIPAA considerations for health systems when communicating with patients via social media.

Can businesses require COVID-19 vaccination proof?

Newsday | April 28, 2021

This article on whether businesses can require vaccination proof from their customers quotes Long Island Health Care associate Michal Ovadia for her outlook on customers that are not able to verify their vaccination status and how this is ultimately uncharted territory.

Amazon's new telehealth service is coming to Massachusetts this summer

Boston Business Journal | March 24, 2021

This article on Amazon’s plan to offer its own telehealth service to the company’s Massachusetts workers this summer quotes Washington, DC Health Care counsel Sarah Swank on potential telehealth challenges once temporary cross-state provider licenses expire 30 days after the state of emergency ends.

Lawsuit Says Missing NH In-Home Care Leads to Nursing Home Stays

Inside Health Policy | January 19, 2021

This article covers a class action complaint filed against the New Hampshire Department of Health & Human Services for failing to properly administer its CFI Medicaid waiver program. NP—together with NH Legal Assistance, Disability Rights Center-NH, and the AARP Foundation—filed the lawsuit in federal court on behalf of older adults and persons with disabilities enrolled in the CFI program. The NP team includes Complex Commercial Disputes partner Dan Deane, associate Kierstan Schultz and paralegal Sharon Willier, and Government Investigations & White-Collar Defense partner Mark Knights, all of Manchester.

Member spotlight

Health Law Connections | October 23, 2020

The latest issue of the American Health Law Association’s magazine includes a Q&A with Washington, D.C. Health Care counsel Sarah Swank. In addition to highlighting Sarah’s practice, the feature covers some of Sarah’s very early roles, family life and how she’s managing through the pandemic.

Healthcare fraud probes grow in number, intensity

Modern Healthcare | October 03, 2020

Chicago Government Investigations & White Collar Defense partner Chis Hotaling is quoted in this article for his outlook on the financial incentive that may be driving larger information requests by government investigators.

Hospitals can transfer patients’ medical debt to RIP Medical Debt, regulators say

Modern Healthcare | July 28, 2020

In this article on the Department of Health and Human Services Office of Inspector General’s advisory opinion that will expand national nonprofit and client RIP Medical Debt’s services, Long Island Health Care partner Michele Masucci is quoted on the legal nuances of the advisory opinion and anti-kickback concerns.

Investigators target fraud that exploits rural hospitals

Modern Healthcare | July 01, 2020

Boston Government Investigations & White Collar Defense partner Brian French is quoted in this article for his outlook on why rural hospitals are easy targets for billing fraud, and which communities are at most risk to be targeted.

COVID-19 GC Roundtable (podcast)

American Health Lawyers Association | April 01, 2020

In this podcast, Washington, D.C. Health Care counsel Sarah Swank speaks with three hospital general counsel on the front lines of the coronavirus pandemic.

Coronavirus sparks demand for local telemedicine, marks turning point for the industry

Washington Business Journal | March 20, 2020

Washington, DC, Health Care counsel Sarah Swank talks about how a new waiver that expanded the list of video conference apps and platforms permitted under HIPAA for telemedicine could be a game-changer for the industry.

Hospitals balance disclosure and privacy as COVID-19 spreads

Modern Healthcare | March 12, 2020

Chicago Health Care partner Valerie Breslin Montague talks about how hospitals can remain in compliance with HIPAA while executing an effective crisis communications plan related to the coronavirus outbreak.

AI in Healthcare – how to avoid fraud and abuse

AIMed | March 09, 2020

Washington, DC, Health Care counsel Sarah Swank wrote this contributed article analyzing how organizations can avoid fraud and abuse pitfalls as clinical AI services become more prevalent in the industry.

Doctors say no secret info used in FCA suit against J&J

Law360 | March 06, 2020

This article mentions Boston Government Investigations and White-Collar Defense partners Hannah Bornstein and Mark Seltzer for their representation of the defendants in a False Claims Act suit centering on faulty hip replacement devices. The defendants have argued the suit should be dismissed on the grounds that confidential information was used in the complaint.

Devicemaker-doctor relationships ripe for fraud litigation

Modern Healthcare | August 23, 2019

This article quotes Washington, DC, Government Investigations and White Collar Defense partner Adam Tarosky for his perspective on the overlap between anti-kickback violations and False Claims Act violations when physicians are accused of accepted improper perks from medical device companies.

Match addresses exactly for off-campus claims or risk denials

Medicare Compliance & Reimbursement | July 10, 2019

This article quotes Chicago Health Care partner Valerie Breslin Montague discussing a new Centers for Medicare and Medicaid Services policy, taking effect in July, that could complicate the billing and reimbursement process for health care providers.

Contacts

Peter Armstrong Egan

Partner
Practice Group Leader, Health Care

pegan@nixonpeabody.com

Phone: 516-832-7633

Rebecca Simone

Partner

rsimone@nixonpeabody.com

Phone: 516-832-7524

Brian K. French

Partner

bfrench@nixonpeabody.com

Phone: 617-345-1258

  • Ranked nationally for Health Care in Chambers USA: America’s Leading Lawyers for Business 2018, as well as in Illinois, Massachusetts and New York
  • U.S. News/Best Lawyers “Best Law Firms” 2020 ranked as National Tier One in: Appellate Practice, Commercial Litigation, Corporate Law, Employment Law—Management, Energy Law, Franchise Law, Health Care Law, Labor Law—Management, Litigation—Construction, Litigation—Labor & Employment, Litigation—Real Estate, Mass Tort Litigation/Class Actions—Defendants, Patent Law, Public Finance Law, Real Estate Law, Securities Regulation, Tax Law
  • In addition, many Nixon Peabody practices received U.S. News/Best Lawyers Tier 1 rankings at the regional level in the following geographies: Albany, NY; Boston; Buffalo; Chicago; Long Island; Los Angeles; Manchester, NH; New York City; Providence, RI; Rochester, NY; San Francisco; and Washington, DC.
  • U.S. News/Best Lawyers has named Nixon Peabody “Law Firm of the Year” in Health Care Law in 2016
  • Ranked nationally in U.S. News/Best Lawyers 2019 “Best Law Firms” in Health Care Law, and received metropolitan rankings in Health Care Law in Albany, Chicago, Long Island, Los Angeles, New York City and Rhode Island
  • Ranked in Illinois, Massachusetts and New York for Health Care in Chambers USA: America’s Leading Lawyers for Business
  • Ranked nationally by Modern Healthcare—Largest Healthcare Law Firm
  • Recognized lawyers by Best Lawyers in America in the field of Health Care law
  • Recognized lawyers by Super Lawyers in the area of Health Care law
  • Recognized by the American Bar Association’s Health Law Section in its Annual Regional Law Firm Recognition Program
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