The Firm regularly represents health care professionals in license, application, revocation and sanction investigations and hearings including before the New York State Office of Professional Medical Conduct, as well as the Department of Education’s professional licensing divisions.  Many of our attorneys regularly participate in the audit process in matters involving the recovery of Medicare and/or Medicaid fees, and have both negotiated settlements and conducted administrative hearings before the New York State Department of Health (Medicaid) and the Centers for Medicare and Medicaid Services (Medicare)  We have also defended various providers in Civil Monetary Actions brought by the Office of Inspector General of the United States Department of Health and Human Services seeking monetary recovery of fees on the basis of allegations involving violations of the Federal Anti-Kickback Statute and the Physician Self-Referral (Stark) Law.  Some of these matters have encompassed the investigative and the hearing stages, allegations involving substance abuse, recordkeeping violations, fee-splitting, fraud, and gross negligence on the part of physicians, physician assistants, dentists, podiatrists, chiropractors, technicians and other licensed health-care professionals, brought by the respective prosecutorial arms of the Health Department or the Education Department.
 
Members of our firm have represented Health Care providers before the various governing bodies of Medicaid and Medicare, involving audits, fraud actions (civil and criminal), over-utilization and sanction and exclusion proceedings involving claims of both fiscal and quality of care issues.  Our firm has represented our professional clients before CMS authorities regarding Medicare, the New York State Department of Social Services regarding Medicaid and the New York State Department of Health’s Bureau of Prescription Control, and various other agencies and peer review organizations.  We have performed numerous audits as part of Independent Review Organizations under Corporate Integrity Agreements.  Our regulatory attorneys identify patterns of fraud and abuse, some of which are often sophisticated, that may reveal violations of the Program Regulations as codified in Title 18, as well as the policies embodied in the Provider Manuals. Our attorneys also have the ability to perform analyses of the providers’ corporate and medical practice structures, including reviewing documentation for compliance under applicable state and federal laws, rules and regulations.  Our Health Care Fraud and Abuse Audits include an analysis of the provider’s agreements and practice structure including the following:

• Examination of all financial relationships with potential referral sources for compliance under the Anti-Kickback Statute
• Examination of all financial relationships with entities that the Provider refers patients for compliance under the Federal (Stark Law) and State Self Referral Laws
• Corporate practice of medicine compliance
• Fee splitting
• Examination of credentials on physicians and other licensed professionals
• Compliance with HIPAA