Health Care Regulatory Law
Regulatory/Compliance
The Watkins Ludlam Health Care Group regularly advises its health care provider clients in regard to compliance with the Medicare and Medicaid Fraud and Abuse laws, the Stark laws regulating physician self-referrals, and state laws prohibiting kickbacks and physician self-referrals. Attorneys have assisted hospitals, academic medical centers, PPMCs, physician organizations, and post acute providers in developing effective corporate compliance programs to prevent, detect, and correct fraud and abuse. Compliance counseling has included:
- directing compliance base-line audits and periodic audits;
- legal review and analysis of operations and contracts;
- review of proposed joint ventures and contractual for compliance with federal and state laws;
- compliance with corporate integrity agreement (including preparation of annual reports);
- repayment methods of federal funds (including discussions with federal intermediaries and carriers and, where appropriate, U.S. Attorneys and
State Attorneys General);
- conducting annual compliance review and updating of compliance documents.
HIPAA/Health Privacy
Watkins Ludlam attorneys have mastered HIPAA's intricacies to provide authoritative counsel to health care clients as they undertake the demanding compliance burdens of the Act and its rules. The three main categories of such services are: assessing and implementing HIPAA compliance plans, including on-site visits as required; providing legal services for covered entities, including employee training; and providing legal services for vendors and service providers (business associates).
Policies and Procedures
The most effective method for avoiding compliance issues and to protect against fraud and abuse is to implement and adhere to a strongly defined set of policies and procedures. Our attorneys work with clients to create such policies and procedures or to review existing manuals to identify deficiencies that may put the organization at risk.
Reimbursement Fraud and Abuse
Watkins Ludlam Winter & Stennis’ practice encompasses all areas of government payor reimbursement fraud and abuse transactions likely to attract the attention of the Inspector General or prosecutors. Our reimbursement work includes planning, judicial challenges to statutory and regulatory provisions of reimbursement programs for various types of clients such as medical centers, medical device manufacturers, trade associations, state hospital associations, trustees in bankruptcy and holding companies that control health care providers. Our fraud and abuse consultation includes planning and structuring transactions to minimize fraud and abuse implications, and for transactions already formulated or implemented, we provide advisory opinions on potential fraud and abuse concerns.