Our Health Services practice works together to assist clients in establishing, implementing, and monitoring compliance programs to prevent, detect, and correct practices or procedures that do not comply with the complex laws governing the provision of, and billing for, health care services. We serve as compliance counsel, participate in and advise compliance committees, and are intimately involved in the compliance process on an ongoing basis for an array of providers and clients.
Working both independently and, when appropriate, with outside consulting firms, our attorneys audit current practices, initiate appropriate corrective measures, and provide ongoing and systematic training and evaluation, while ensuring that our reviews and discussions remain privileged and confidential to the maximum extent possible. We have extensive experience counseling clients on compliance with federal and state statutes and regulations, including:
- Medicare and Medicaid anti-kickback laws
- Stark laws and related self-referral prohibitions
- The False Claims Act
- Other laws presenting risks for potential criminal and civil liability
In addition, Nixon Peabody attorneys have been involved in many recent False Claims Act-driven government investigations, including:
- Emergency room E&M coding initiatives
- Laboratory unbundling initiatives
- Pneumonia upcoding reviews
- Laboratory investigations
- Investigational devices issues
- PATH audits and investigations
- DRG 72-Hour Window claims
We have a broad and deep array of experience counseling and defending clients in connection with the investigation and prosecution of health care fraud allegations by federal and state entities, including the U.S. Department of Health and Human Services, Office of the Inspector General, New York’s Office of the Medicaid Inspector General, U.S. Department of Justice, and New York’s Medicaid Fraud Control Units. We also have extensive experience negotiating and fulfilling the obligations under corporate integrity agreements.