Fraud and Abuse

The integrity of healthcare programs is a top priority for multiple agencies and contracted entities on behalf of those programs, as 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 eradicate 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, The Health Law Group works with providers 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 Health Law Group’s activities in the fraud and abuse area include:

  • Analysis of proposed business transactions for compliance with the Anti-Kickback Statute, Stark Law, Civil Monetary 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 for program integrity.
  • Development of voluntary corporate compliance programs.
  • Defense of False Claims Act and Qui Tam actions.
  • Incident investigations and development of corrective action plans.
  • Defense of pre and post-payment review and overpayment determinations.
  • Defense of proposed exclusions from Medicare and Medicaid.
  • Assisting with Voluntary Disclosure to the Office of Inspector General and the Centers for Medicare and Medicaid Services (CMS).