Health care providers face unprecedented scrutiny at both the state and federal level, with the government announcing annually its record recoveries in the billions of dollars. Virtually every aspect of providers’ operations are now subject to either an audit or investigation, or both. In addition to having one of the largest health care groups in the country, we also have one of the largest groups devoted to responding to government audits and investigations. We assist our clients in responding to these audits from their inception through the appeal phase and final resolution. Some of the audits and investigations that we assist our clients with include:
  • RAC audits (From Level 1 through federal court appeal)
  • ZPIC audits
  • False claims act investigations
  • OIG civil monetary penalties investigations
  • Criminal investigations involving the anti-kickback statute and other criminal laws
  • Special issues in behavioral health 
  • Medicaid audits
  • OCR data breach investigations
  • HIPAA audits (including meaningful use)
  • 340B audits
  • Medicaid Fraud and Control Units (MFCUs) investigations
  • Payment suspension appeals and related litigation

In addition to having one of the largest health care groups in the nation, we have a team with deep practical experience that gives us tremendous insight when responding to an audit or investigation. Our team includes:
  • Former general counsel of the American Hospital Association
  • Former U.S. Attorney, Assistant U.S. Attorneys and Special Assistant U.S. Attorney, all of whom have significant experience with health care fraud cases
  • An attorney who previously worked at a relator firm
  • Former Office of Civil Rights attorney, who focused on data breach investigations
  • Former director of a state Medicaid Program
  • Three nurse attorneys
  • Physician attorney
  • Physical therapist attorney
  • Former hospital accountant
  • Former health care consultants

In certain instances, our clients may also access the firm’s public policy arsenal to reach federal agencies if and when it becomes necessary for intervention at the executive policy level.

Our health care team has also developed an efficient process for handling Recovery Audit Contractor (RAC) audits and appeals, and we are committed to providing turn-key service through each step with seamless integration. Lastly, we have been successful in representing nationally and internationally known health care institutions in civil and criminal health care fraud investigations involving the Department of Justice, OIG, FBI, and Medicaid Fraud Control Units.
  • Defended a publicly traded medical device manufacturer in a criminal investigation that was ultimately referred by the Department of Justice to the Office of Inspector General and was successfully settled through administrative resolution.
  • Retained by a large health care company to develop a strategy for growth through the use of joint ventures with physicians. By involving key internal stakeholders, including the company's compliance and legal departments, developed standards and a process that has effectively allowed growth while also avoiding unnecessary legal risk.
  • Representing medical device manufacturers and other health care providers in connection with criminal and civil investigations under federal fraud and abuse laws and regulations.
  • Retained by pharmacy benefit manager in large national investigation to conduct internal investigation and advise Board of Directors of potential liability.
  • Defended specialty pharmacy organization in OIG investigation, resulting in closure of the investigation without any penalties or sanctions.
  • Defended a medical practice in an investigation of medical director fees and E&M coding. Investigation was terminated by the Department of Justice without a settlement demand.
  • Defended a medical practice in a coding and billing investigation that was based on Department of Justice data analysis. Successfully removed several government contentions and resolved the matter on reasonable terms for the client.
  • Represented numerous hospitals in diagnosis-related group coding investigations. Developed a process for exploring factual issues and supporting codes used by hospital coders. Effective use of certain coding has helped drive favorable settlements for clients.
  • Conducted an internal review of potential noncompliance with Stark Law. Developed practical parameters to assess risk and to explore remediation efforts. Developed legal framework to resolve potential issues.
  • When a large oncology practice discovered a pattern of possible upcoding and questionable billing conduct by one of its physicians, assisted the client in assessing its risk and mitigating potentially material liability through the use of an overpayment refund process.
  • Developed a strategy to respond to a state survey agency’s interpretation of the Life Safety Code. After a detailed review of the licensure regulations and the code itself, developed an advocacy strategy that led to the survey agency clarifying its position to be consistent with the client's historical approach.
  • Obtaining favorable settlement of numerous state and Federal False Claims Act investigations without resulting exclusions, implementation of Corporate Integrity Agreements or other Settlement Agreement Integrity Provisions.
  • Structuring and conducting internal investigations, including experience with document review, evaluation of business relationships and interviews of staff members.
  • Represented health systems, home-health providers, and physicians during federal and state investigations.
  • Resolution of Medicaid overpayment investigations without imposition of penalties.
  • Representing long term care company is parallel civil and criminal health care fraud investigation led by the Department of Justice.
  • OCR investigation of community hospital for alleged data breach and retaliation (retaliation allegations dismissed).
  • Investigation of large medical group for alleged Stark Law violations related to compensation plan for employed cardiologists (DOJ declined to intervene and relator voluntarily dismissed the case).
Past Events