Health Care Compliance / Fraud and Abuse

The Robinson+Cole Health Law Group has extensive experience with all facets of health care compliance and fraud and abuse issues. We have provided compliance counsel and assistance and representation for publicly traded, privately held, nonprofit, for-profit, and other health care provider entities, including hospitals, physician hospital organizations, physician groups and individual practices, home health care and nursing home providers, dialysis suppliers, and others involved in health care delivery. Robinson+Cole lawyers have extensive experience assisting health care providers with the full spectrum of health care compliance, audits, self-reporting, and fraud and abuse analysis and defense issues. We have assisted a broad range of clients with the development and ongoing operation and review of compliance programs, compliance initiatives, and other responses to the rapidly changing health care regulatory landscape. Such assistance ranges from providing advice and counsel on health care compliance on specific issues to determine whether an appropriate compliance response or corrective action may be necessary to responding to fraud and abuse investigations.

Robinson+Cole assists clients in establishing and evaluating compliance programs with particular focus on federal and state fraud and abuse false claims acts, the Stark law, and other compliance-related matters. Such counseling includes internal counseling and review in a preemptive manner, as well as responding to investigations and other enforcement initiatives. Robinson+Cole has assisted clients to assess appropriate structures for compliance programs, including development of written policies and procedures, development of compliance training programs and initiatives, and periodic review and redesign of monitoring and reporting systems.

Given the broad depth of experience of our health care lawyers, we have assisted clients with reviewing and developing of a number of voluntary self-disclosure matters as well as responding to investigative subpoenae and other enforcement actions. While focused on prevention before issues arise, Robinson+Cole is also well positioned to respond to government investigations and audits that are becoming increasingly prevalent in the highly regulated health care marketplace.

In addition, Robinson+Cole counsels clients in transactions to ensure compliance with federal, state, antikickback, and physician self-referral laws. Such experience and background allows us to counsel clients on structuring compliant arrangements at the start of negotiations and as transactions proceed.

    • Experience
      • Regular representation of hospitals, integrated delivery systems, nursing homes, continuing care retirement communities, physician groups, outpatient clinics and other health care providers as outside general counsel. Regularly advise these clients in matters of corporate governance, contracts, regulatory compliance, corporate compliance, risk management, policies, fundraising and tax exemption, employment, labor and litigation. Work closely with senior management and/or general counsel in transactional and day-to-day risk management and operational issues.
      • Representation of tissue bank in connection with negotiations and drafting of distribution, supply, licensing, representation and other agreements; acquisition of substantially all of the assets of another tissue bank; creation of domestic and international joint venture; subsidiary arrangements for the provision of certain tissue products and services; and certain regulatory matters.
      • Regular representation of hospitals in connection with physician recruitment and retention matters, including advice regarding Stark exceptions, Anti-kickback safe harbors and tax exemption restrictions and drafting of income guarantees, loan forgiveness arrangements and employment agreements.
      • Representation of hospital in connection with formation of professional corporation for employment of physicians in private practice model.
      • Regular representation of hospitals and physician groups in connection with physician and mid-level provider employment agreements, including advice regarding Stark and Anti-kickback statute compliance, incentive compensation and gainsharing issues.
      • Regular advice to and representation of clients in proceedings before the Connecticut Department of Social Services regarding financial audits, administrative sanctions and Title XIX appeals.
      • Representation of one of Connecticut’s largest providers of home health services in connection with a multi-agency federal and state investigation into the company’s billing practices. Worked closely with the client to conduct an internal investigation of the agency’s billing processes to identify potential areas of exposure and to develop a comprehensive corporate compliance program. Successfully persuaded the United States Attorney’s Office not to pursue charges and to issue a formal declination letter.
      • Representation of a hospital network and behavioral health center in an investigation of billing practices brought by the Federal Bureau of Investigation and the Office of the Inspector General.
      • Representation of a Connecticut hospital in connection with quality of care investigation by the Connecticut Department of Public Health. Prepared and defended witnesses in interviews with state investigators, coordinated all aspects of compliance with document demands, and appeared in related individual licensure hearings on behalf of the facility.
      • Regular representation of hospitals, outpatient clinics, nursing homes and physician groups in connection with service contracts, including without limitation, contracts with providers of durable medical equipment, pharmacy, clinical laboratory, infusion services and staffing services.
      • Representation of an emergency medical service corporation and principals in criminal investigation involving potential Medicare fraud. Avoided prosecution and termination of Medicare participation status through negotiated resolution of civil monetary penalties.
      • Regular representation of institutional health care providers in connection with financial audits and quality of care investigations relating to the Medicaid and Medicare programs conducted by the Connecticut Department of Social Services and the Connecticut Department of Public Health.
      • Regular representation of not-for-profit health care providers in connection with corporate reorganizations, governance issues and revisions to corporate governance documents.
      • Representation of home care agency in connection with acquisition of the assets of another home health care agency.
      • Representation of hospital in the development of a managed residential community and the licensing of an assisted living services agency, including without limitation, development of the assisted living services agreement, development and negotiation of a management agreement and development of policies.
      • Representation of joint venture between tax exempt hospital and physicians in connection with development and operation of ambulatory surgery center, including drafting Operating Agreement, drafting private placement memorandum and subscription agreements, fraud and abuse analysis, and drafting and negotiating land option agreement and lease, management agreement and anesthesiology service agreement.
      • Representation of physician group in the formation of a joint venture with a hospital for outpatient radiology services, including drafting and negotiation of an Operating Agreement, management agreement, billing services agreement, imaging services agreement and lease agreement.
      • Regular representation of hospitals in connection with exclusive professional service agreements for radiology, anesthesiology, pathology and radiation oncology.
      • Regular representation of hospitals, community providers and physician groups in connection with corporate compliance plans.
      • Regular advice to hospitals regarding issues involving EMTALA, including compliance and EMTALA’s physician on call requirements.
      • Representation of individual physicians and professionals in the negotiation of employment contracts.*
      • Representation of provider in response to third party payor, Medicare and OIG post payment audit and investigation.*
      • General counsel to multi-state pathology group practice.*
      • Representation as deal counsel in affiliation of nursing home system and adult day care system.*
      • Regulatory counsel to multi-state dialysis company.*
      • Representation of a home and hospice care provider in a disaffiliation from a large health care system and conversion to a freestanding entity, including negotiation of deal terms, representation before the Attorney General's office on the proposed use of non-profit foundation assets and representation before the Department of Health for regulatory approval and transfer of ownership licenses.*
      • Representation of buyers and sellers of physician practices and structuring of buy-in and earn-out provisions for physicians joining or leaving a practice.*
      • Representation of cardiology group practice in negotiation of exclusive cardiology services agreement with community hospital cardiology program joint venture.*
      • Representation of diagnostic imaging centers in the development of MRI, PET, and nuclear cardiac testing facilities and related regulatory, reimbursement, and contract issues.*
      • Development of corporate compliance programs for hospitals, nursing homes, physician groups, academic medical center foundation, imaging company, and a computer services company.*
      • General corporate advice to multi-state restaurant company and its shareholders.*
      • Representation of providers in connection with federal and state subpoena and investigation of possible Medicare and Medicaid overpayments, false claims, and related issues and negotiation of settlements with U.S. Attorney, HHS-OIG, and state Medicaid fraud control units.*
      • Compliance, regulatory, EMTALA, and HIPAA counseling of national behavioral health company and dialysis services companies.*
      • Representation of a nursing home in connection with a complete revision of its Medical Staff Bylaws and Rules and Regulations, including revisions to ensure compliance with applicable statutes, regulations and accreditation standards of agencies such as Joint Commission on Accreditation of Health Care Organizations, Centers for Medicare and Medicaid Services and the Connecticut Department of Public Health.
      • Representation of a continuing care retirement community in connection with restructuring and revising their continuing care contracts.
      • Representation of physician hospital organization in connection with purchase of electronic medical record hardware and software, including fraud and abuse and tax exemption advice regarding donation of electronic medical record software and services by a hospital to physicians, structuring the transactions between the physician hospital organizations and the physician users and hospital donor and drafting and negotiating all contracts with the electronic medical record vendor and the physician users.
      • Representation of hospital in connection with acquisition of middleware software for electronic health records, including fraud and abuse and tax exemption advice in connection with the donation of such software to physicians.
      • *These matters were of counsel prior to an individual attorney joining Robinson+Cole.

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