The healthcare industry has always been highly regulated, and increasingly so. We assist our clients in responding to regulatory inquiries, and in complying with state and federal statutory and regulatory requirements.
We counsel clients regarding their obligations, and compliance with, HIPAA, Stark, Anti-kickback, False Claims Act, Medicare, EMTALA, HCQIA and other federal statutes, as well as the wide array of state regulation. Our attorneys develop compliance programs for clients, as well as HIPAA Business Associate Agreements. We have performed a number of internal investigations and compliance audits. On behalf of our clients, we negotiate with CMS (formerly HCFA), OIG, DHHS, IRS and the Justice Department on the federal level and the Insurance Department, Department of Health and the Attorney General’s Office in Pennsylvania, and several states.
Our attorneys have extensive experience with Credentialing and Peer Review issues, covering the process and the privilege, as well as the requirements and impact of the National Practitioners’ Data Bank. We are also very experienced with practice management issues, including antitrust, reimbursement contracting, capitation and billing issues with the government and insurers, managed care companies and third party administrators, as well as benefit determination issues, including Coordination of Benefits and Pennsylvania Act 6.