Areas of Expertise
Government Investigations, White Collar Litigation, and Healthcare Fraud Defense
Local, State and Federal Agencies use criminal and administrative statutes and regulations to investigate and pursue suspected healthcare fraud. Private Healthcare carriers use the Audit Provisions in the Provider Contract to retrieve medical and billing documentation for the same purpose. These sometimes parallel investigations require the experience and knowledge our firm attorneys posses in order to navigate these dangerous waters.
Our focus is in providing top notch service to healthcare professionals in the areas of audit defense, criminal defense and other related legal matters such as disciplinary investigations and hearings by hospitals and licensure boards that place professional reputations, careers and futures at risk. The matters are critical and complex. We have built a reputation for effective representation in these matters.
We have successfully handled the ever-changing healthcare needs in the following areas:
• Private healthcare insurance carrier audits and investigations alleging fraud.
• Civil litigation brought by Local, State and Federal agencies involving allegations of fraud or abuse.
• Representation in connection with Local, State and Federal investigations or demands.
• Licensure and disciplinary investigations by Licensure Boards, hospitals and health systems including medical staff disputes/investigations, credentialing issues, disruptive physician allegations and privilege issues.
Medicare and Insurance Carrier Audits, Investigations and Compliance
Federal and State authorities pursue suspected healthcare fraud by using various statutes and regulations such as the Mail Fraud Statute, Federal False Claims Act, Anti-Kickback, Stark Self-Referral Law, and Healthcare Fraud Statute. Local and State authorities use the State Insurance Fraud Statute to pursue suspected fraud and abuse by healthcare providers and businesses. Private healthcare carriers use the Audit provision and policies contained or referred to in their contracts to investigate allegations of fraud and abuse.
We regularly provide guidance and advice to clients in response to inquiries, investigations, medical file and document demands made by the governmental agencies and the private healthcare carriers. At times the inquiries, investigations and document demands made by the private carrier can overlap with the government’s demands. We navigate these demands and guide our clients through the complex policies, provider contracts, regulations, billing codes and statutes that serve as the basis for those demands.
We regularly and successfully handle cases in the audit arena, involving:
• Medicare audits and investigations.
• RAC audits.
• Medicaid audits and investigations.
• Health and Human Service, Office of Inspector General investigations.
• Private healthcare carrier audits and investigations.
• Overpayment demands by private healthcare carriers.
• Civil litigation brought by private healthcare carriers involving allegations of fraud or abuse.
• Medicare or Medicaid exclusion litigation.
Licensure Defense Civil Litigation
Our attorneys are experienced advisors who have handled the litigation needs of our healthcare clients which involve contract disputes, employment agreements, restrictive covenants, non-competition agreements, hospital separation agreements and business disputes including the following:
• Lease Agreement litigation.
• Employment litigation.
• Physician Contract litigation including enforcement of restrictive covenants.
• Enforcement of non-compete provisions.
• Physician/partner separation agreement and litigation.
With respect to disciplinary investigations and licensure defense matters, we represent a broad spectrum of healthcare professionals from the initial investigative inquiries through final resolution. Our representation includes providing counsel in the flowing areas:
• Contact by the Bureau of Enforcement and Investigation (BEI).
• Contact by the Pennsylvania Department of State, Bureau of Professional
and Occupational Affairs (BPOA).
• Disciplinary investigations by hospitals.
• Disciplinary hearings by hospitals and health systems.
• Medical Executive Committee hearings and reviews.
• Credentialing and privilege and medical staff litigation.
Responding and defending matters involving sexual misconduct, harassment, dating violence, and stalking and bullying on college and university campus and conducting an investigation of the complainant’s allegations. Responding to the complaint’s by conducting a thorough investigation on behalf of the client throughout the entire course of the Title IX or code of conduct review.