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BakerHostetler’s Healthcare Industry team includes attorneys who dedicate their practices to representing healthcare providers in a wide range of administrative, civil False Claims Act (FCA) and criminal healthcare fraud enforcement matters.

We are highly skilled in the numerous areas that are subject to enforcement, including referral relationships and anti-kickback statutes, Health Insurance Portability and Accountability Act (HIPAA), coding and billing issues, and medical necessity.

Government Investigations and Enforcement

We offer significant experience navigating all types of government enforcement matters in healthcare fraud and abuse, including civil FCA investigations, criminal healthcare fraud enforcements and administrative healthcare matters.

Our highly skilled team possesses a wealth of knowledge in areas subject to enforcement, including referral relationships, coding and billing and medical necessity issues, as well as compliance with the federal Anti-Kickback Statute and HIPAA.

  • Represented academic medical centers, hospitals and health systems, physicians, and other providers in conducting internal billing compliance audits and self-disclosure submissions to Medicare and Medicaid payors.
  • Represented academic medical center in a self-disclosure to the OIG regarding outpatient billing errors, including Evaluation and Management (E&M) services, Ambulatory Payment Classifications (APCs) and observation services.
  • Represented hospitals in the investigation and evaluation of the appropriateness of certain “short stay” inpatient admissions, including assistance with the voluntary disclosure of identified overpayments based on such investigations, when necessary.
  • Represented hospital in self-disclosure to the OIG related to Stark Law violations involving physician relationships.
  • Represented academic medical center before the DOJ, the OIG and the Medicare carrier on issues related to teaching physician documentation and Medicare billing rules.
  • Represented client in a state inspector general action and administrative litigation to recover alleged Medicaid overpayments, resulting in substantial reduction in overpayment demand and favorable settlement for client.
  • Represented large physician group in negotiating a settlement of possible civil and administrative claims arising out of submission of claims for services of an excluded physician.
  • Represented hospitals and physicians in compliance matters related to illegal remuneration, Stark Law and Civil Monetary Penalties Law issues.
  • Represented healthcare providers in administrative appeals before state and federal agencies, including issues related to graduate medical education, disproportionate share payments, and compliance with grants and licensing.
  • Represented medical device company with respect to allegations of kickbacks and potential off-label use.
  • Represented multiple pediatric rehabilitation facilities in relation to administrative investigations by the state inspector general regarding alleged beneficiary inducements and billing for medically unnecessary services.
  • Represented health system with respect to allegations related to Medicare coverage of implantable cardioverter defibrillators.
  • Represented university faculty plan related to an audit of Medicare and Medicaid billings.
  • Represented mobile diagnostic testing company in relation to Medicare Fraud Strike Force investigation and prosecution targeting multiple individuals and businesses for healthcare fraud and money laundering.
  • Represented home health agency with respect to healthcare fraud grand jury investigation and forfeiture of bank accounts.
  • Represented former officer of large diagnostic testing laboratory in relation to criminal administrative subpoena requests.

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