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

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

Reuters Legal | April 16, 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 16, 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 12, 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 05, 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 22, 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 19, 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 17, 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.

What do companies need to know to avoid legal missteps?

MedCity News | June 15, 2017

Los Angeles IP counseling and transactions associate Erik Birkeneder and health care associate Daniel Eliav co-authored this article about legal issues digital health companies should consider.

6 Ways to Be a Go-To Firm for HIPAA Compliance

Law360 | April 29, 2016

Chicago health care partner Valerie Breslin Montague is included in this piece that looks at how attorneys are dealing with increasing Health Insurance Portability and Accountability Act (HIPAA) penalties and audits.

  • Ranked nationally for Healthcare in Chambers USA: America’s Leading Lawyers for Business 2018, as well as in Illinois, Massachusetts and New York
  • 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 “Best Law Firms” in Health Care Law and received metropolitan rankings in Health Care Law in Albany, Boston, Chicago, Los Angeles, New York City and Rhode Island
  • Ranked in Illinois, Massachusetts and New York for Healthcare 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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