Healthcare: Fraud and Abuse

Because healthcare fraud and abuse laws are complex and contain significant enforcement penalties, healthcare entities need guidance from legal teams that have seen it all. Our team includes former government enforcement lawyers who can anticipate enforcement trends for both providers and payors.

We counsel clients on compliance design and risk mitigation, and represent them in civil and criminal False Claims Act (FCA), Anti-Kickback Statute (AKS), and Physician Self-Referral (Stark Law) litigations and investigations initiated by the U.S. Department of Justice (DOJ) or whistleblowers. We also represent our clients in audits or administrative proceedings with the Centers for Medicare and Medicaid Services (CMS), U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), state Medicaid agencies, and other administrative bodies. We zealously represent our clients' interests in enforcement matters whether administrative or in the courts.

We also help clients navigate federal prohibitions and their state equivalents, including anti-kickback prohibitions and their safe harbors and physician self-referral prohibitions and their exceptions. Our team advises clients on compliance with federal statutes providing for civil monetary penalties and exclusions under the federal healthcare programs. We also assist clients with voluntary disclosures, utilizing the advisory opinion process and understanding sub-regulatory guidance and pronouncements from HHS-OIG and CMS.

Whether the application of the fraud and abuse laws relates to a billing or coding issue or a business transaction, our attorneys guide clients through constructing a transaction to avoid risk and understanding reimbursement rules to prevent violations.