Fraud & Abuse

Health care providers operate in a highly regulated business environment that impacts every part of their business—from day-to-day operational issues to large transactions. Some of the highest legal risk areas that health care providers face include the fraud and abuse laws, including the Anti-Kickback Statute (AKS), Stark Law, False Claims Act (FCA), and Civil Monetary Penalties (CMP) Law. These laws are designed to protect the Medicare and Medicaid Trust Funds, but often pose significant operational challenges for arrangements between health care providers and other entities. HDJN’s fraud and abuse attorneys understand the complexity and nuances of these laws, and advise health care providers in structuring compliant arrangements while maximizing business goals. We also help clients through internal compliance investigations and self-disclosure to the government, when necessary.

Fraud and Abuse Services:

  • Anti-Kickback Statute (AKS)
  • Stark Law
  • False Claims Act (FCA)
  • Civil Monetary Penalties (CMP) Law
  • State Self-Referral Laws
  • Beneficiary Inducement Statutes
  • Development of Physician Compensation Models
  • Fraud Investigations/Audits by the ZPIC, OIG, and DOJ
  • Requests for Advisory Opinions from the OIG
  • OIG Exclusion
  • Voluntary Refunds to Medicare Contractors
  • OIG Self-Disclosure Protocol
  • CMS Self-Referral Disclosure Protocol
  • Self-Disclosures and Settlement Negotiation

Anytime the fraud and abuse laws are implicated, the stakes are high. HDJN’s attorneys provide practical advice to help health care providers reduce risk and resolve fraud and abuse issues.

Contact:

James (Jim) M. Daniel
James (Jim) M. Daniel
Mary C. Malone
Mary C. Malone