Healthcare Attorneys Representing Providers Nationwide
The healthcare industry is one of the most tightly-regulated in the country. All types of healthcare providers, ranging from large health systems to single-physician practices, are subject to a complex web of federal and state regulations. And these regulations touch on virtually every aspect of a provider’s operations from patient safety to patient information privacy to billing. Penalties for non-compliance with these regulations can be severe and adversely impact a provider’s bottom line or even the provider’s ability to continue operating in the industry.
Our attorneys represent all types of providers before federal and state agencies, courts, and administrative tribunals around the country in issues related to regulatory compliance, reimbursement, enrollment, transactions, and licensing. Given the ever-increasing regulatory burdens placed on healthcare providers, it is critical that providers seek the advice of experienced counsel when it matters most.
Federal and state agencies, along with commercial insurance carriers, have grown increasingly aggressive in recent years when it comes to the investigation of regulatory non-compliance and suspected waste, fraud, and abuse. These enforcement actions can take the form of audits, large overpayment assessments, terminations, revocations, the imposition of civil monetary penalties, and exclusions. In civil or administrative cases, providers are frequently targeted for violations that include but are not limited to:
- Billing for services that do not meet applicable coverage criteria.
- Filing false claims.
- Failure to maintain complete and up-to-date enrollment information with all insurance payors, including Medicare and Medicaid.
- Failure to adequately safeguard confidential patient information.
- Referral of certain types of services to an entity, such as a lab or a home health agency, in which the physician has a financial interest.
- Relationships where something of value, whether in cash or in kind, is exchanged for the purpose of inducing referrals.
Civil and administrative investigations in the healthcare field are never conducted at random. Through the use of sophisticated data analysis tools, government agencies and commercial insurance payors are able to identify and target suspect providers with precision. Providers should educate themselves regarding the types of regulatory violations that most often trigger healthcare audits and enforcement actions and know when to consult with a qualified healthcare attorney. If you have any questions or concerns regarding these issues, contact Calhoun Bhella & Sechrest to set up a consultation.
The intricate web of laws and regulations that govern the healthcare field adds a layer of complexity to transactions that isn’t present in many other industries. Our experienced team of transaction attorneys represents all types of providers to guide them through all aspects related to entity formation, corporate governance, due diligence, mergers, and acquisitions.
We negotiate, draft, and advise clients on all types of agreements, such as employment contracts, purchase agreements, leases, non-compete agreements, third-party biller contracts, and management services organization (MSO) agreements – just to name a few. If you are contemplating a transaction or want a contract drafted or reviewed, contact one of our experienced healthcare attorneys today to request a consultation.