Practice/Industry Group Overview
Due to increased governmental regulation of health care providers, Marshall Dennehey Warner Coleman & Goggin has formed an interdisciplinary practice group to advise, guide and defend our health care provider clients as they navigate the myriad regulations that continue to be imposed upon them. The Health Care Governmental Compliance Practice Group consists of attorneys experienced in the practices of health law, white collar crime, criminal defense and employment law. The team members are seasoned litigators who are equipped to represent health care providers at every level.
Whether a large urban hospital system or a small physician practice, most providers will inevitably encounter the scrutiny of state and federal regulators. Our group is prepared to meet the needs of clients to assist them in this confusing "alphabet soup" of regulation.
- Conduct and oversee internal audits and investigations of compliance issues
- Assist providers in defending against alleged overpayments and making self-disclosures to federal and state agencies when necessary
- Counsel providers in making repayments of funds
- Counsel clients regarding Stark and anti-kickback issues
- Draft agreements to comply with Stark and anti-kickback laws
- Investigate claims of off-label use by pharmaceutical manufacturers in connection with governmental investigations
- Represent providers in False Claims Act investigations and in cases brought by qui tam relators
- Negotiate Corporate Integrity Agreements on behalf of providers
- Assist providers in responding to governmental audits, such as RAC and ZPIC audits
- Assist providers in obtaining reimbursement for covered services from Medicaid and other managed care organizations
- Assist providers facing prepayment reviews of claims submissions and medical documentation as a result of alleged billing, coding and documentation issues
- Counsel providers on proposed legislation and the implications of such legislation on their respective practices and professions, including development of comments and proposed amendments to legislative bills and participation in public hearings to address those comments and proposed amendments
Mark Mattioli and Kate McGrath have represented health care providers for a collective 50 years. They are keenly aware of the challenges that providers face in efforts to establish effective compliance programs and are eager to assist in the development of such programs. Mark and Kate also have a long history of defending health care providers when litigation ensues. Jack Gruenstein, Mike Turner and Kevin Hexstall have significant experience in white collar civil and criminal defense, each with a legal career spanning 15 years or more. They are solidly prepared to respond to government subpoenas and to guide health care providers through the process. Ronda O'Donnell, an experienced litigator from our Employment Law Practice Group, provides valuable insight and experience when health care providers are faced with whistle blower/qui tam actions.
The members of our Health Care Governmental Compliance Practice Group are uniquely situated to service our health care providers. We make ourselves available to give lectures, seminars and presentations on issues of mutual concern. We are committed to providing a blend of dedication, geographical coverage and cost-effectiveness to achieve the best results for clients.
Articles Authored by Lawyers at this office:
Courts Differ on Healthcare Reform
Mark L. Mattioli, July 26, 2014
Yesterday, two separate courts of appeals rendered contrary decisions on whether the subsidy provision of the Affordable Care Act (ACA) applies in states that have opted not to run their own insurance exchanges. Currently, only 14 states have established their own exchanges, while 36 states,...
Feds Are Serious About Data Security
Mark L. Mattioli,David J. Shannon, April 22, 2014
In what could be a landmark ruling in the data breach legal field, a New Jersey district court recently ruled that the FTC's lawsuit against Wyndham Hotels for unfair and deceptive trade practices related to a major data breach could proceed. Although the breach did not happen in a health care...
Defending the Compelled Use of Arbitration Agreements
Jason P. Ferrante, December 18, 2013
On September 9, 2003, an Ohio appellate court published its opinion in McFarren v. Emeritus at Canton, 2013 Ohio App. LEXIS 4058 (Ohio Ct. App. Sept. 9, 2013). The opinion is contrary to fairly recent United States Supreme Court law that bolstered the compelled application of binding arbitration...
The Difference between “I’m Sorry” and “I Was Wrong.”
Mary Kate McGrath, October 21, 2013
In June 2013, the Pennsylvania Senate passed the Senate Bill No. 379, the Benevolent Gesture Medical Professional Liability Act, also known as the Apology Act. The bill, which passed the Pennsylvania House of Representatives, returns to the House in the fall 2013 to pass the Senate’s version,...
Landmark False Claims Act Judgment Imposed For Stark Violations
, October 07, 2013
Tuomey Healthcare System is facing the largest False Claims Act verdict ever issued against a not-for-profit hospital. This ruling came on September 29, 2013, when the court ordered that Tuomey pay the sum of $237,454,195 to the United States government and qui tam relator, Michael L. Drakeford,...
Inpatient Admission Update: Rebilling, Two Midnights and Admission Certifications
Stephanie M. Barr, September 27, 2013
Beginning in October we will see big changes in the world of reimbursement, especially regarding inpatient services under Medicare Part A. The Fiscal Year 2014 Inpatient Prospective Payment System (IPPS) Final Rule (CMS 1599-F) has a significant impact on billing for inpatient admissions and it...