Partner Linda Baumann was recently quoted in the Bloomberg BNA article, “Health Fraud Rule Withdrawal May Hurt Enforcement Efforts,” appearing in both the Health Care Daily Report and the Medicare Report. The article discusses how fraud enforcement efforts in the health care industry may be hindered by the Trump Administration’s delay of a program integrity final rule that would have strengthened the government’s ability to suspend or revoke provider enrollment in Medicare and Medicaid.
Fraud & Abuse Compliance
Arent Fox is an industry leader on the numerous complex legal requirements that apply to relationships among providers, suppliers and other companies doing business in the health care industry, as well as their relationships with physicians. Our lawyers are nationally recognized for their expertise and experience counseling clients on the Anti-Kickback Statute, the Stark Law, the False Claims Act, the laws relating to beneficiary inducement prohibitions, civil monetary penalties, exclusion, fee splitting, the corporate practice of medicine, and their State counterparts. In addition, Arent Fox attorneys have deep experience with the myriad Medicare and Medicaid reimbursement issues that often form the basis for fraud and abuse enforcement.
We have advised hospitals and health systems (including specialty hospitals such as LTACHs, children’s hospitals and AMCs), nursing homes, hospices, home care agencies, medical device and pharmaceutical manufacturers, ambulatory surgery centers, clinical laboratories, therapy companies, and a broad range of other health care providers and suppliers, as well as clinical researchers and health care practitioners.
Our team is at the forefront of health care compliance and includes professionals with decades of experience counseling clients on complex regulatory matters, including former HHS and OIG counsel, a Medicaid Inspector General, certified professional coders and clinicians as well as nationally recognized experts in the fraud and abuse laws and Medicare requirements.
Our practice includes advising clients on the development and implementation of strategies to minimize exposure under the fraud and abuse laws; working proactively with management, employees and Board members to develop effective compliance programs, policies and training tailored to the specific regulatory environment. We help conduct internal audits to evaluate specific regulatory issues as well as overall compliance program effectiveness. Arent Fox attorneys frequently assist clients in determining when a compliance failure creates overpayment liability, assessing the scope of potential liability and making disclosures to the appropriate government entity.
Another key part of our practice involves guiding clients through government-initiated audits, limiting the audit’s scope where possible, and preempting unnecessary disputes and litigation. Where our clients have been unable to avoid litigation, we have won and successfully settled many major cases.
We have experience defending matters related to:
- Billing and coding errors (or alleged fraud) related to Medicare and Medicaid payment and coverage requirements (on issues ranging from inpatient admission/observation status to the DRG payment window, appropriate level of supervision, use of modifiers, and services furnished by excluded providers)
- Government medical reviews, audits and investigations initiated by agencies such as the Department of Justice (DOJ), the Office of Inspector General of the Department of Health and Human Services (OIG), the Medicare Administrative Contractors (MACs), the Recovery Audit Contractors (RACs), the Zone Program Integrity Contractors (ZPICs), and Medicaid Fraud Control Units (MFCUs)
- Challenging overpayment determinations (especially by RACs) through administrative appeals
- Clinical research fraud
- Challenging billing privilege suspension, revocation or program enrollment termination.
Our attorneys understand the collateral consequences that can result from fraud and abuse investigations, and we help clients avoid or defend against exclusion, suspension, or debarment.
On May 6, 2016, CMS published in the Federal Register a request for comments on proposed revisions to the information to be collected pursuant to the CMS Voluntary Self-Referral (Stark) Disclosure Protocol (SRDP). The proposed revisions introduce a new SRDP submission form and update the requirements of the SRDP to reflect recent regulations that require providers to self-disclose overpayments going back up to six years, when appropriate.
In March 2012, the Centers for Medicare & Medicaid Services (CMS) enhanced its Medicare enrollment screening for new and existing enrollees to the Medicare program. Providers not meeting CMS’s enhanced enrollment screening risk denial, revocation, or deactivation of Medicare billing privileges.
The Centers for Medicare & Medicaid Services recently issued final regulations implementing the Stark Law as part of the Physician Fee Schedule for 2016. While many of the changes are intended to make it easier for providers to comply with the Stark Law’s complex requirements, that should not engender a false sense of security.
Federal prosecutors appearing at the American Conference Institute’s 16th Annual Forum on Fraud and Abuse in the Sales and Marketing of Medical Devices earlier this month outlined recent enforcement trends that should catch the attention of the health care industry. Companies that ignore the warnings and lessons stemming from these public comments do so at their own peril, especially with regard to the False Claims Act.
Health Care partner Linda Baumann was recently selected as a member of the Law360 Health editorial advisory board. The purpose of the editorial advisory board is to gain insight from experts on developments in the field and how best to shape future coverage. Linda Baumann heads the Washington, DC office of the Arent Fox Health Care group. She counsels clients nationwide on compliance, False Claims Act cases, internal investigations, self-disclosures, CIAs as well as the Stark Law and Anti-Kickback Statute.
On Friday, February 12, 2016, the Centers for Medicare and Medicaid Services (CMS) released the long-awaited Final Rule and regulations, providing much needed guidance to providers and suppliers on how to meet the Affordable Care Act’s (ACA’s) 60-day overpayment mandate. Specifically, a provision enacted as part of the ACA in 2010 requires that all Medicare and Medicaid overp
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Arent Fox LLP, founded in 1942, is internationally recognized in core practice areas where business and government intersect. With more than 350 lawyers, the firm provides strategic legal counsel and multidisciplinary solutions to clients that range from Fortune 500 corporations to trade associations. The firm has offices in Los Angeles, New York, San Francisco, and Washington, DC.