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Health Care Regulation

In the highly regulated health care industry, Faegre Baker Daniels counsels medical providers and suppliers on compliance with state and federal health care regulations related to referrals, reimbursement and other issues.

Referrals

We have substantial experience helping physicians and other providers comply with referral limitations imposed by the Anti-Kickback Statute and the Stark Act. We advise on which entities are subject to prohibitions and we develop financial arrangements between referral sources that meet applicable safe harbors or decrease risk over time.

Billing and Reimbursement

Health care providers risk violating the False Claims Act when they submit claims for payment to federal government payers. We assist clients in mitigating False Claims Act risks and advise on other billing and reimbursement regulations regarding Medicare Parts A and B, DMERC, Medicaid/Medical Assistance, and Corporate Integrity Agreement compliance and resolution.

Health care providers, including physicians and hospitals, must be prepared to respond to Recovery Audit Contractor (RAC) audits reviewing Medicare payments. In preparation, we conduct internal audits for clients, assemble responses to RAC requests and train personnel.

Compliance Programs

All health care providers—including hospitals, physician practices and home health agencies—should develop vibrant compliance programs decrease risk of violations. Our professionals use their in-house backgrounds to provide practical advice on developing, implementing, monitoring and documenting such programs. 

Defense

When faced with litigation, arbitration or government investigations, clients in the health care industry turn to us for counsel. We have represented major hospitals and health care systems, physician groups and other providers in complex, high-stake litigation and government investigations throughout the United States, negotiating favorable settlements for our clients. We have advocated for providers before state health departments, the Office of the Inspector General, the Department of Justice, Department of Health and Human Services, Center for Medicare and Medicaid Services, and many other state and federal agencies.

Other Regulatory Matters

We advise on a number of other health care regulatory matters, including:

  • Licensing
  • Abuse and anti-dumping laws
  • Antitrust laws
  • HIPAA
  • Emergency Medical Treatment and Active Labor Act
  • Public entity law
  • Acquisition and disposition of health care entities
  • Operational structure
  • Compliance with accreditation standards of the Joint Commission on Accreditation of Health Care Organizations

Contact

Thomas S. Schroeder, Minneapolis
+1 612 766 7220


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