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Investigations, Audits, and Regulatory Compliance

Overview
Garfunkel Wild’s Investigations, Audits and Regulatory Compliance Practice Group is comprised of a team of experienced attorneys who focus on the unique regulatory and business concerns of the health care industry.  Our attorneys are counsel to a wide variety of providers, including hospitals and health systems, licensed clinics, skilled nursing facilities, physician practices, clinical laboratories, pharmacies, and community based providers.  We routinely advise clients on federal and state Stark and anti-kickback laws and their applicable exceptions and safe harbors, False Claims Acts, Medicare and Medicaid billing and enrollment issues, health care fraud, professional misconduct rules, and other fraud and abuse laws. 

Our team is adept at handling complex matters and is well-known for providing practical, real-word compliance advice that clients can implement in their day-to-day operations.  With a team of attorneys who are former government prosecutors and criminal defense attorneys, we vigorously defend clients in federal and state criminal, civil and administrative investigations, as well as payer audits, and counsel clients through government oversight actions, such as Corporate Integrity Agreements. 
 
The Investigations, Audits and Regulatory Compliance Practice Group advises our clients in the following representative areas:
 
  • Development and implementation of effective corporate compliance programs
  • Internal Investigations
  • False Claims Act investigations
  • State and Federal criminal health care fraud investigations
  • Responding to government inquiries and subpoenas
  • Payor and government Audits
  • Nursing Home regulatory issues, investigations and appeals of deficiencies/citations
  • Review of compensation methodologies under Federal and State “Stark” and Antikickback Laws
  • Review of compliance with billing rules and regulations (e.g., “incident-to” rules, modifier use, out of network billing)
  • Medicare/Medicaid enrollment, revocation, and exclusion matters
  • Office of Professional Medical Conduct (“OPMC”) matters
  • Legal audits of relationships under “Stark,” Antikickback and related laws
  • Regulatory issues related to Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
  • Clinical Laboratory compliance, billing and investigations