The fiscal and programmatic integrity of federal and state healthcare programs is a priority for multiple federal and state agencies and contracted entities on behalf of those federal programs. The government continues to devote substantial resources to the battle to insure the integrity of government run healthcare programs. The acronyms for these agencies and contractors are numerous, but the common purpose of these entities is to ferret out fraud and abuse. However, the question is most often whether there is actual fraud or abuse or simply good faith errors made in the face of overwhelmingly complex regulations and requirements.
As counsel for healthcare providers, Kathleen L. DeBruhl & Associates works with providers and their local legal counsel both to avoid any likelihood of fraud and abuse investigations and to defend those subject to investigation whether in an audit, a request for information, or full fledged investigation and prosecution.
The Firm’s activities in the fraud and abuse area include:
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Analysis of proposed business transactions for compliance with Anti-Kickback, Stark, Civil Money Penalties and billing requirements
- Opinions of counsel regarding proposed transactions and preparation of requests for advisory opinions to governmental agencies regarding proposed transactions
- Defense of audits by various governmental agencies and contractors, including Medicare carriers and fiscal intermediaries, Medicare Program Integrity Contractors, and Medicaid contractors and program integrity
- Development of voluntary corporate compliance programs
- Defense of false claims and qui tam actions
- Incident investigations and development of corrective action plans
- Defense of pre and post payment review and overpayment determinations
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Defense of proposed exclusions from Medicare and Medicaid
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Assisting with Voluntary Disclosure to the Office of Inspector General and the Centers for Medicare and Medicaid Services (CMS)
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