Practice Areas & Industries: Baker, Donelson, Bearman, Caldwell & Berkowitz, PC

Practice/Industry Group Overview

The Baker Donelson Health Law Department 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. Baker Donelson 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;
• Directing charge master audits;
• Legal review and analysis of operations and contracts; and
• Advising compliance officers on:
  • Investigation of complaints received through compliance communications process;
  • Internal review of billing and coding questions;
  • Review of proposed joint ventures and contractual arrangements 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; and
  • Advising officers and directors on corporate responsibility and compliance.

Services Available

The Health Law Department has developed training programs for employees and professionals and structured compliant health care business arrangements, including joint ventures, physician recruitment and employment, purchases of physician practices, personal services and management contracts, leases, group purchasing and managed care activities.

Baker Donelson attorneys have assisted their clients in making voluntary disclosures of billing errors to the Fiscal Intermediary or Department of Justice and in responding to enforcement initiatives by the Department of Health and Human Services, the Department of Justice and state Medicaid fraud control units. We have represented our clients in Administrative Law Judge hearings and have negotiated settlements and corporate integrity agreements with U.S. Attorneys and the CMS (HCFA) Office of Counsel.

Representative Matters

• Served as outside compliance counsel for hospitals, physician groups and laboratory clients, advising compliance officers and corporate boards.
• Advised providers on federal regulatory, fraud and abuse and state medical licensure issues.
• Obtained OIG Advisory Opinion with respect to transfer of control of a hospital system's CRNA program to its anesthesia group.
• Directed internal investigation and audit of a physician practice related to a nurse practitioner's incident to billing.
• Restructured purchasing organization for compliance with the GPO and Discount Safe Harbors.
• Represented numerous health care companies with self-reporting of overpayments and negotiating settlements.
• Successfully appealed the exclusion of a provider from the Medicare program.
• Disputed and successfully appealed cost disallowances by the Medicare Fiscal Intermediary.