Fraud and Abuse

Our attorneys have significant experience in health law transactions and fraud and abuse compliance, allowing us to evaluate and structure transactions to minimize the risk of violating state and federal laws.  We also advise clients regarding fraud and abuse concerns related to existing transactions and develop compliance plans to minimize the risk of prohibited activity and conduct investigations and audits.

 

In the event of a violation, we assist clients in self-reporting and returning any overpayments to applicable payers, including the Medicare and Medicaid programs.  When necessary, our attorneys work closely with experienced criminal defense attorneys in connection with actual or potential criminal investigations. We have successfully represented and defended clients involved in criminal, civil and administrative fraud and abuse investigations, conducted by the Office of Inspector General, Department of Justice, United States Attorney, and the Arizona Attorney General.

 

Our experience includes:

  • Representing physicians and physician group practices in negotiating and drafting physician recruitment agreements with hospitals;
  • Structuring joint ventures (including ambulatory surgery centers, imaging centers (IDTFs), and other diagnostic and therapeutic facilities) among physicians, for-profit and non-profit hospitals and management companies;
  • Advising physician group practices regarding the distribution of income from ancillary services under the federal Stark Law;
  • Advising businesses within the health care industry in connection with transactions and contractual relationships with health care providers and suppliers;
  • Representing a large, multispecialty physician group practice under investigation by the Office of Inspector General for violating Medicare billing rules governing physicians at teaching hospitals (PATH);
  • Representing a physician group practice under criminal and civil investigation for violating the federal Stark Law, Anti-Kickback Act and False Claims Act with respect to the group’s relationship with a non-profit hospital;
  • Negotiating settlement and corporate integrity agreements on behalf of physicians and physician groups under investigation for fraudulent billing;
  • Representing physician group practices who have entered into corporate integrity agreements regarding compliance audits conducted by the Office of Inspector General;
  • Drafting and implementing compliance plans for small and large single-specialty and multi-specialty physician group practices and other health care providers, suppliers and businesses in the health care industry;
  • Investigating and auditing suspected fraudulent billing practices on behalf of health care providers and suppliers;
  • Representing physician group practices under civil investigation for violating the Federal Stark Law and False Claims Act with respect to the group’s ancillary designated health service venture;
  • Representing physician group practices in the disclosure and repayment of AHCCCS and Medicare collections billed in error.