Loading

REGULATORY COMPLIANCE

We counsel all types of health care providers on compliance with federal and state laws, regulations, standards and policies with a focus on post-acute care, including:

 

Reimbursement

 

  • Medicare and Medicaid reimbursement rules
  • Long-term acute care hospitals (LTCHs)
  • Inpatient rehabilitation facilities (IRFs)
  • Inpatient psychiatric facilities (IPFs)
  • Outpatient rehabilitation clinics
  • Skilled nursing facilities
  • Home health
  • Hospice

 

Licensure & Certificate of Need (CON)

 

  • State licensure requirements, including assistance with applications and approvals
  • State certificate of need requirements, including assistance with applications and approvals
  • Notifications, applications and approvals in connection with changes of ownership

 

Certification & Accreditation

 

  • Medicare and Medicaid certification requirements, including assistance with applications and approvals
  • Counseling on Medicare conditions of participation and Joint Commission standards, including advice on effective responses to survey deficiencies and plans of correction
  • Qualifications for exemption from the inpatient hospital prospective payment system (IPPS) for LTCHs, IRFs and IPFs
  • Specific requirements for hospitals-within-hospitals (HwH or HIH), satellite facilities, remote locations, and provider-based entities

 

Transactional Due Diligence

 

  • Document review and interviews to confirm compliance of acquisition targets with federal and state regulatory requirements, including Medicare and Medicaid reimbursement, licensure, certification, accreditation, certificate of need
  • Notifications, applications and approvals in connection with changes of ownership, including written analysis of same and summary chart with all timeframes to successfully coordinate transfer to new owner

 

Fraud & Abuse Laws

 

  • Advice on how to properly structure new and existing arrangements to meet a safe harbor or otherwise comply with federal and state fraud and abuse laws, including the principal federal laws:
    • Anti-kickback statute
    • Physician self-referral ("Stark") law
    • Civil monetary penalties law
    • OIG exclusion authority
    • Federal False Claims Act (FCA)
  • Represent clients in investigations conducted by The Department of Health & Human Services (HHS), the HHS Office of Inspector General (OIG), and other federal health care programs, including responses to subpoenas, legal analysis of issues, defense, and negotiated settlements
  • Assist providers with negotiating corporate integrity agreements and alternatives with the OIG

 

Compliance Programs

 

  • Assistance with structuring or amending corporate compliance programs for hospitals and other health care providers
  • Advise corporate compliance officers and departments regarding internal audits and complaints, and any necessary corrective actions
  • Conduct legally privileged external audits of compliance issues and advise clients on corrective actions, including disclosures and repayments