Healthcare Fraud & Abuse

As state and federal governments increase regulation, expand enforcement efforts and intensify scrutiny of healthcare industry transactions and operations, healthcare entities need guidance from lawyers who know their industries, understand their legal requirements and can help them prevent, detect and resolve fraud and abuse issues.

Dickinson Wright lawyers possess that combination of skills. We regularly offer proactive counsel, assisting clients with:

  • Assessing and structuring client business transactions to minimize the risk of violating state and federal fraud and abuse laws, including those with referral sources.
  • Handling government investigations and resolving potential fraud and abuse investigations and/or litigation.
  • Establishing, monitoring and enforcing effective corporate compliance programs. 
  • Developing processes that will keep existing compliance policies current and effective.
  • Conducting thorough, discreet and efficient self-audits, gap analysis and internal investigations.
  • Implementing internal reporting and self-disclosure processes.
  • Negotiating corporate integrity agreements and providing compliance training.
  • Complying with EMTALA, licensure/certification, HIPAA, HITECH and Sarbanes-Oxley requirements, among other laws.
  • Assisting in the negotiation, preparation, and/or maintenance of all contracts and leases with referral sources that are needed to assure compliance with healthcare fraud and abuse and related laws.

We also keep clients current on the latest legal trends and the requirements and standards of the Office of Inspector General, Office of Civil Rights and other similar authorities.

When a violation occurs, we advise on disclosure obligations, self-reporting and remediation efforts and we defend our clients in government investigations and litigation. Among our areas of expertise are advising on and defending corporations, officers, directors, employees and other individuals regarding: 

 

  •  The False Claims Act.
  •  Unfair Trade Practices.
  •  Federal and State Anti-Kickback Statutes.
  •  Secondary Payor Issues.
  •  The Physician Self-Referral Law  (Stark Law).
  •  Civil Enforcement Initiatives, Including Licensing and Exclusion from Federal Programs.
  • The Civil Monetary Penalties Law. 
  •  Grand Jury Subpoenas and Proceedings.
  •  The Criminal Health Care Fraud Statute.
  •  Search Warrants.
  •  Foreign Corrupt Practices Act and Qui Tam related matters.
  •  Negotiations with Prosecutors.
  •  Medicare and Medicaid Reimbursement Regulations.
  •  Criminal Pleas, Trials and Sentencing.
  •  The Exclusion Authorities.
 

Team lawyers litigate in courts of all levels and have effectively resolved investigations conducted by the Department of Justice, United States Attorneys' Offices, the Office of Inspector General at the U.S. Department of Health and Human Services, and state Medicaid fraud enforcement authorities.