Fraud and Abuse
Federal and state fraud and abuse laws affect virtually every healthcare provider transaction and all aspects of provider operations.
Powers Pyles Sutter & Verville serves healthcare providers on two fronts in this field. Our experience enables us to interpret complex provisions to offer meaningful, practical solutions to compliance issues and to guide client transactions and develop corporate compliance programs so that investigations and sanctions under fraud and abuse laws are avoided. Our careful monitoring and analysis of regulatory agency actions allows us to distill this intelligence and proactively report to clients on the potential impact of pending legislative and regulatory action on operations and compliance efforts.
Powers counsels clients on compliance with all federal and state fraud and abuse laws, including:
- Stark self-referral law
- Anti-kickback statute
- False Claims Act
- Civil Monetary Penalties law
- Similar state provisions
Fraud Investigation and Prosecution
Prosecutors and regulatory agencies nationwide have dramatically increased their investigative and prosecutory efforts targeting healthcare providers, utilizing recently-expanded criminal, civil and administrative enforcement powers as a key strategy in the process. Powers attorneys are well equipped to handle all types of investigations and enforcement proceedings and have attained considerable success on behalf of clients. We have resolved investigations through obtaining criminal declinations or negotiating favorable civil settlements with the government.
Powers represents and defends clients in every phase of the investigative process, including:
- Administrative and Office of Inspector General investigations and proceedings
- FCA investigations
- Grand Jury proceedings
- Independent counsel and Congressional investigations
- Civil and criminal litigation
Our attorneys have extensive experience and powerful resources to pursue the most favorable outcome for our clients. We apply persuasive strategies at the negotiating table during interaction with prosecutorial agencies; in litigation, our aggressive advocacy results from our significant experience representing clients in hundreds of court actions before all administrative agencies and tribunals in the federal, state and local courts.
Internal Investigations and Self Disclosure Matters
Powers routinely assists its healthcare provider clients in conducting internal investigations and evaluating potential report and repay obligations under the Medicare 60-day repayment rule. We frequently assist our clients in preparing reports for submission to the OIG’s Self Disclosure Protocol and the CMS Self-Referral Disclosure Protocol. We have an excellent track record of working with the enforcement agencies to achieve positive results and minimize the disruption caused by these investigations, by demonstrating credibility through full and fair disclosure.
Powers has extensive experience assisting a wide range of healthcare providers in developing and implementing corporate compliance programs. Our experience includes:
- Assistance with identification of reimbursement and related areas to be addressed in the compliance plan
- Providing legal advice on requisite features of a compliance plan
- Furnishing practical advice on how to implement the plan within provider operations
- Addressing perceived or actual problems detected through compliance initiatives, including voluntary self-disclosure
- Protection from qui tam suits
Powers also counsels clients regarding the EMTALA anti-dumping provisions, including the development of policies and protocols to comply with EMTALA rules and, if necessary, providing representation if an investigation of noncompliance is undertaken by federal authorities.Download PDF