Regulatory & Compliance/Audit & Appeals

The federal and state health care fraud and abuse laws are both comprehensive and complex. Members of the Benesch Healthcare Practice Group are extremely conversant with the (1) federal anti-kickback statute, safe harbor regulations, case law, Office of Inspector General (“OIG”) advisory opinions, “fraud alerts” and other issuances by the OIG and the Centers for Medicare and Medicaid Services (“CMS” (formerly the Health Care Financing Administration); (2) “Stark” (physician self-referral) statute, regulations, case law and advisory opinions; (3) federal statutes establishing criminal offenses and grounds for civil monetary penalties and exclusion under the federal Health Care Programs; (4) federal False Claims Act and case law (including matters relating to private “whistleblower” actions); and (5) OIG Voluntary Disclosure Protocol. By drawing on our vast contacts within the health care industry, we have keen insight into the emerging trends and proposed regulations that impact your business. We can anticipate how potential industry changes might affect your prospects and legal risks and will counsel you on them so you can improve and protect your business and take advantage of new opportunities. Our industry connections also allow us to be advocates for our client’s business. Knowing how heavily regulated the health care industry is, we proactively build relationships with those who influence those regulations: industry leaders and their entities, legislative and regulatory bodies, and individual legislators and regulators. We can then amplify our clients’ voices on matters crucial to their success by furnishing industry leaders with insight on how proposed laws, rules and regulations might hurt or help the industry. We assist clients with compliance-related matters such as conducting internal investigations, drafting policies and procedures, implementing compliance programs, and training management and sales forces.