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

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.

Health records law moves slowly

Buffalo Law Journal | July 09, 2018

Albany Health Care partner Laurie Cohen is quoted in this article discussing how state and federal guidance are encouraging patients to be more engaged with their health records, and outlining instances in which minors can withhold health information from their parents.

U.S. Supreme Court declines to review whistleblower case against J&J's DePuy

Reuters Legal | April 15, 2018

In the following coverage, Boston government investigations and white-collar defense partners Mark Seltzer and Hannah Bornstein are mentioned for their ongoing representation of Johnson & Johnson and its subsidiary DePuy Orthopaedics Inc. in a False Claims Act case. The Supreme Court recently declined to review the First Circuit’s ruling in the case.

J&J won't get high court look at FCA 'particularity' rule

Law360 | April 15, 2018

In the following coverage, Boston government investigations and white-collar defense partners Mark Seltzer and Hannah Bornstein are mentioned for their ongoing representation of Johnson & Johnson and its subsidiary DePuy Orthopaedics Inc. in a False Claims Act case. The Supreme Court recently declined to review the First Circuit’s ruling in the case.

J&J unit wants whistleblower docs in hip implant FCA suit

Law360 | April 11, 2018

Boston government investigations and white-collar defense partners Mark Seltzer and Hannah Bornstein are mentioned in this article for representing Johnson & Johnson Services Inc. and its subsidiary DePuy Orthopaedics in a suit alleging violations of the False Claims Act.

New Hampshire Hospitals Win Challenge to Medicaid Payment Rules

Reuters | April 04, 2018

Litigation department chair Scott O’Connell is quoted in this story involving Nixon Peabody’s representation of an association of New Hampshire hospitals in its successful appeal against the U.S. Centers for Medicare & Medicaid Services. The lawsuit relates to a policy change about how Medicaid payment are calculated.

NH hospitals fight to keep CMS suit win at 1st Circ.

Law360 | November 21, 2017

This article mentions Boston commercial litigation associate Morgan Nighan and Manchester commercial litigation partner and litigation department head Scott O’Connell for representing New Hampshire hospitals in an ongoing dispute involving a Centers for Medicare & Medicaid services reimbursement policy. Scott is also quoted.

Three shady—and all too common—things that digital health startups do to make money

CNBC | November 18, 2017

Los Angeles health care partner Jill Gordon, who this article identifies as a “top lawyer” in the digital health space, provides in-depth commentary regarding the three common practices she’s seen among health technology startups that may violate medical regulations and what companies should be aware of to avoid costly penalties.

Three shady—and all too common—things that digital health startups do to make money

CNBC | November 16, 2017

Los Angeles health care partner Jill Gordon, who this article identifies as a “top lawyer” in the digital health space, provides in-depth commentary regarding the three common practices she’s seen among health technology startups that may violate medical regulations and what companies should be aware of to avoid costly penalties.

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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