Practice Areas & Industries: Marshall Dennehey Warner Coleman & Goggin, P.C.

 




Health Care Governmental Compliance Return to Practice Areas & Industries

Group Profile Lawyers in this Group Offices Locations for this Group
 

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:

House Bill 373 Enacted to Control the Level of Workers’ Compensation Insurance Premiums by Making Significant Changes in the Medical Reimbursements Allowable Under the Healthcare Payment System
Paul V. Tatlow, August 06, 2014
This Act makes substantial changes to Titles 18 and 19 of the Delaware Code designed to control the level of workers’ compensation premiums in Delaware. The most significant changes are: (a) a 33% reduction in medical costs to the workers’ compensation system, phased in over a period of...

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,...

Opening the Floodgates for Runaway Jury Verdicts? Florida Supreme Court Declares Caps on Noneconomic Damages Unconstitutional in Medical Malpractice Wrongful Death Litigation
Chanel A. Mosley, June 04, 2014
On March 13, 2014, the Florida Supreme Court declared unconstitutional the caps on damages applicable to wrongful death claims in a medical malpractice cause of action. Estate of McCall v. United States, 2014 Fla. LEXIS 933 (Mar. 13, 2014). In a 5-2 ruling, Justice R. Fred Lewis wrote the opinion...

Opening the Floodgates for Runaway Jury Verdicts? Florida Supreme Court Declares Caps on Noneconomic Damages Unconstitutional in Medical Malpractice Wrongful Death Litigation
Chanel A. Mosley, May 29, 2014
On March 13, 2014, the Florida Supreme Court declared unconstitutional the caps on damages applicable to wrongful death claims in a medical malpractice cause of action. Estate of McCall v. United States, 2014 Fla. LEXIS 933 (Mar. 13, 2014). In a 5-2 ruling, Justice R. Fred Lewis wrote the opinion...

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...

Patients’ Right To Access Records Of Health Care Facility/Provider Relating To Adverse Medical Incident Not Limited To Only Records Pertaining To Same/Similar Condition, Treatment Or Diagnosis As Patient Requesting Access
Chanel A. Mosley, March 28, 2014
Known as “Amendment 7,” Article X, Section 25 of the Florida Constitution guarantees patients the right to have access to any records made or received in the course of business by a health care facility or provider relating to any adverse medical incidents.

Recovery of Emotional Distress Damages in a New Jersey Medical Malpractice Action Remains a Tough Hurdle for Plaintiffs
Nicholas A. Rimassa, March 28, 2014
The plaintiff parents brought their 19-month-old daughter to the emergency room at 5:00 pm following difficulty breathing and cold or flu-like symptoms. The child was followed by a pediatric intensivist through the night, who claimed to have called a pediatric cardiologist at approximately 12:00 am...

Prescribing High Potency Medication To a Known Drug Abuser: Is the Doctor Liable For Resulting Injuries?
Julia A. Klubenspies, March 14, 2014
The New Jersey Supreme Court recently heard oral argument on a case involving a patient with a known drug abuse history who swallowed medication from a prescription, high-potency skin patch, which ultimately lead to anoxic brain injury. The question before the Supreme Court is whether the trial...

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...

How Many Occurrences Have Occurred Where the Occurrence Occurs Under Statutory MCARE Coverage?
Michelle L. Wilson, December 18, 2013
The Pennsylvania Supreme Court recently addressed the meaning of “occurrence” with regard to the limits of coverage provided by the Medical Care Availability and Reduction of Error Fund (Fund) on matters that fall under the “extended claim” provision at § 715 of the...

Delaware Supreme Court Concludes That Medical Bills of A Non-Certified Provider Are Not Compensable Because Preauthorization Was Necessary
, November 26, 2013
In Wyatt v. ResCare Home Care (decided November 20, 2013)-a case argued by Linda Wilson of our Wilmington, Delaware, office-the Delaware Supreme Court rejects the Superior Court’s decision in Vanvliet v. D&B Transp., 2012 WL 5964392 (Del. Super. Ct. Nov. 28, 2012) and holds that the medical...

Claimant’s Medical Expert’s Testimony Regarding the Cause of the Decedent’s Death Was Not Equivocal Simply Because the Expert Offered Alternate Theories Regarding the Exact Cause of Death.
Francis X. Wickersham, October 21, 2013
The claimant filed a fatal claim petition, alleging that the death of his decedent was caused by injuries he sustained from a fall from a crane platform at work. The decedent and a co-worker were working, without harnesses, on an elevated crane platform with no handrails approximately six feet from...

New Jersey Supreme Court Rules Patients First Act Requires High Threshold for Expert Witness Qualifications in Malpractice Cases.
Michael G. Daly, October 21, 2013
The New Jersey Supreme Court reversed the lower court’s decision to allow expert testimony from a witness who did not “specialize” in the same field of medicine as the defendant-physicians. Nicholas involved a malpractice claim against two physicians, among others, for the alleged...

Payment of Medical Payments Over an 18-Month Period by the Employer was Done under a Feeling of Compulsion and Thereby Tolled the Statute of Limitations.
Paul V. Tatlow, October 21, 2013
This case was tried before the Superior Court regarding the employer’s appeal from a Board decision that granted the claimant’s petition to determine additional compensation due by awarding payment of medical expenses as well as a counsel fee. The Board had concluded that the...

Provision in a Financial Agreement that Contravenes the Intent of the Medical Malpractice Act by Limiting Damages is Void as against Public Policy.
Chanel A. Mosley, October 21, 2013
Joseph Franks sought medical care and treatment from Dr. Bowers and his surgical group at North Florida Surgeons, P.A. Prior to undergoing surgery, Mr. Franks executed a financial agreement that contained a provision for arbitration. The arbitration provision contained a limitation of damages...

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,...

Health Care Reform: Marketplaces and Medicaid Expansion and an Update for the Tri-State Area
Stephanie M. Barr,Shannon L. Brainard, September 27, 2013
Open enrollment for the health care market place has finally arrived. Soon, qualified individuals and small businesses will be able to purchase Qualified Health Plans (QHPs) through the Health Insurance Marketplaces (also called health insurance exchanges). With the Marketplaces and Medicaid...

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...