Practices: Fraud and Abuse/Self-Referral

Any healthcare provider could face allegations of fraud and abuse under federal and state laws regulating kickbacks and physician self-referral, as well as Medicare and Medicaid billing and reimbursement rules. Increasingly, such allegations expose providers and provider organizations to the possibility of monetary penalties and even criminal prosecution. You need proactive guidance that keeps you in compliance, and effective defense in case allegations of misconduct arise.

Proactive Counsel

Hospitals, physician groups, clinical laboratories, nursing homes and home health agencies are just some of the healthcare providers that benefit from our detailed working knowledge of federal and state anti-kickback laws and physician self-referral statutes. Chief among these are the Anti-Kickback Statute and Stark Law. Our attorneys will work with you to identify the safe harbors that apply to your operations, then structure employment contracts, joint ventures, lease arrangements and other transactions so that they are in compliance. Your board of directors members will benefit from our extensive experience at advising board members on proper approaches to financial relationships with referral sources, hospital-owned physician practices and other aspects involving fiduciary responsibilities. Our capability to perform fraud and abuse due diligence reviews in connection with acquisitions, joint ventures, and comprehensive management agreements gives you additional compliance assurance.

Compliance Help

We help clients implement compliance programs that ensure observance of federal and state fraud and abuse laws. Senior administrators and boards of directors of healthcare providers get compliance strategies structured to meet their management approach, whether it emphasizes overall proper conduct and general ethical values, or technical legal compliance. You get our help to review and confirm (or uncover problems with) your current compliance efforts, and to create policies, procedures, oversight and training to ensure ongoing compliance. That includes all necessary steps to:

• Review organizational documents, meeting minutes and relevant contracts.
• Interview key personnel.
• Draft compliance procedures.
• Create a training curriculum.
• Develop a filing system and document retention policy.
• Formulate a plan of graduated discipline.
• Provide ongoing counseling and support.

Enforcement Experience

Because members of our firm have been senior enforcement officials in both the United States Attorney’s and Illinois Attorney General’s offices, we know how to structure internal investigations and litigation defenses that meet the government’s enforcement tactics head-on. And our extensive relationships with former FBI, DEA and IRS agents enable us to put superb investigative resources at your service. If you face a False Claims Act investigation by the HHS Office of the Inspector General, you can confidently turn to us knowing that we have successfully represented providers like you in investigations, administrative proceedings, and civil and criminal trials involving fraud and abuse allegations.

Should you face government allegations of misconduct, we will conduct witness interviews and review all documentation, evaluate the results, and help you form an appropriate response – whether to formal or informal government inquiries, or to search warrants and subpoenas. You get effective representation in all phases of administrative, civil and criminal litigation involving allegations of false claims act violations, including qui tam whistle-blower cases, as well as federal and state anti-kickback statute cases. We negotiate settlement agreements and corporate integrity agreements with the Department of Justice and the Office of Inspector General, and will help you implement the terms.

Knowledgeable and Sophisticated

While complex laws, rules and regulations affect all health care organizations, those involving allegations of inappropriate self-referrals or Medicare/Medicaid other third-party payor reimbursement fraud involve particularly aggressive regulatory and enforcement scrutiny. Every healthcare organization faces potential civil or criminal liability because of the impact these laws have on their staff, finances and operations. Your need for knowledgeable guidance and sophisticated advice has never been greater. Ungaretti & Harris has the experience to give you both, from proactive identification of safe harbors and fiduciary counseling to vigorous defense against civil or criminal allegations.