Tom is nationally recognized for his experience with fraud and abuse. Practicing in Boston and Washington, DC, he advises national and local clients on structuring complex strategic affiliation arrangements and transactions to comply with the applicable fraud and abuse laws as well as the variety of other regulatory requirements to meet today's health reform challenges. His work in defending clients against anti-kickback, Stark Law, false claims, and whistleblower allegations includes litigation, internal investigations, voluntary disclosures, and negotiating settlements and Corporate Integrity Agreements (CIAs).
He has appeared before numerous US attorneys' offices, the FBI, and the Office of Inspector General (OIG) around the country. In addition, he has served as an expert witness and consulting expert in health care fraud cases.
In addition to his fraud and abuse defense work, Tom advises clients on the legal, practical, and fraud and abuse implications of business arrangements and sales and marketing practices. This part of his practice focuses on Medicare and Medicaid fraud and abuse compliance and reimbursement issues and related laws, including the federal Physician Payments Sunshine Act, 'meaningful use' of EHR technology, under arrangement and provider-based rules, and OIG issues.
Tom has implemented and audited comprehensive corporate compliance programs for clients in various health care sectors.
His clients have included hospital systems and executives, medical device and pharmaceutical manufacturers, pharmacy benefit management companies, physicians and groups, renal dialysis providers, supply companies, home care providers as well as national and state trade groups.
Tom has served in leadership positions with the American Health Lawyers Association (AHLA), the largest organization of health care attorneys in the country. He has written numerous articles, lectures frequently to health care providers and attorneys critiquing government fraud and abuse enforcement policies, and has extensive knowledge regarding the ethics of financial relationships among health care providers.
He became nationally known for his work on the anti-kickback statute during his tenure at the Office of Inspector General at the Department of Health and Human Services in Washington, DC. In particular, Tom gained recognition as a prosecutor in the Hanlester Network joint venture case and as the principal author of the 1991 safe harbor regulations.
Awards & Recognitions
•Recognized by the The Legal 500 United States for Healthcare: Service Providers (2014)
•Best Lawyers in America: Health Care Law (2011 - 2015)
•Chambers USA: Massachusetts - Healthcare (2009 - 2012)
•Massachusetts Super Lawyers: Criminal Defense: White Collar (2004 - 2012)
•Martindale-Hubbell AV Preeminent
•Nightingale's Healthcare News: Outstanding Fraud and Compliance Lawyers (2004)
• Co-author, Proposed Rule Issued by OIG Realigns Its Enforcement Views with Health Care Reform Goals , Health Care Alert ( 10.09.2014 )
• Author, Court Sides with CMS Stark Regulations on Physician-Owned Under Arrangement Service Providers , BNA's Health Care Fraud Report ( 07.24.2013 )
• Author, Federal District Court Upholds Stark Regulation Ban on Physician-Owned Under Arrangement Service Providers , Health Law Advisory ( 06.19.2013 )
• Co-author, CMS Publishes Final Sunshine Act Rule Creating New Regulatory Landscape for Physician-Manufacturer Interactions , BNA's Health Care Fraud Report ( 03.06.2013 )
• CMS Publishes Final Sunshine Act Rule; Data Collection to Begin on August 1, 2013 , Health Law Alert ( 02.04.2013 )
• Sunshine Act Rule Reference Chart , Health Law Alert ( 02.04.2013 )
• Co-author, HHS Issues Report to Congress on the Self-Referential Disclosure Protocol , BNA's Health Care Fraud Report ( 04.04.2012 )
• Co-author, Proposed Physician Payment Sunshine Act Regulations Leave Many in the Dark , BNA's Health Care Fraud Report ( 01.25.2012 )
• Co-author, Delicate Balance: Waiver of Fraud and Abuse Laws and Implementation of Program Integrity Requirements for the Medicare Shared Savings Program , BNA's Health Care Fraud Report ( 11.30.2011 )
• Co-author, Will the Supreme Court Weigh In? Implied Certification Theory Under The False Claims Act , Health Care Enforcement Defense Advisory ( 10.17.2011 )
• Co-author, The Bundled Payments Initiative - A Non-ACO Approach to Promoting Coordinated Care , Health Law Advisory ( 09.16.2011 )
• Co-author, Seventh Circuit Upholds Conviction of a Physician for a Violation of the Anti-Kickback Statute , Health Care Enforcement Defense Advisory ( 06.09.2011 )
• Co-author, CMS and OIG Issue Joint Notice, Solicit Comments Related to Waivers of Fraud and Abuse Provisions for Accountable Care Organizations , Health Care Reform Alert ( 04.06.2011 )
• Co-author, Stark Law Update: CMS Finalizes Rule Regarding Disclosure Requirements for Certain In-Office Ancillary Services , Health Care Reform Alert ( 11.04.2010 )
• Co-author, CMS Implements Self-Referral Disclosure Protocol Process to Self-Disclose Stark Law Violations , Health Care Reform Alert ( 09.27.2010 )
• Co-author, Medicare in the 21st Century: Achieving Quality and Efficiency Through Payment and Service Delivery Reforms , BNA's Medicare Report ( 04.23.2010 )
• Co-author, Risky Business: Health Care Reform's Fraud-Fighting Provisions Increase the Potential for Liability for All in the Health Care Industry , BNA Health Care Fraud Report ( 04.07.2010 )
• Co-author, Payment Reform-A Catalyst for Increased M&A Activity , Health Care Reform Advisory ( 01.21.2010 )
• Co-author, Solidarity in a Sea of Dissent: Consistencies Between the House and Senate Bills' Provisions Targeting Fraud and Abuse , Health Care Reform Advisory ( 12.28.2009 )
• Co-author, The Health Care Fraud Enforcement Juggernaut Continues , BNA Health Care Fraud Report ( 07.29.2009 )
• Author, Self-Disclosure of Overpayments and Violations of Healthcare Laws , Journal of Health & Life Sciences Law ( 01.01.2008 )
• Co-author, Health Care Article: Tennessee Settlement Shows Failure to Refund Overpayments Can Be a Crime , BNA's Health Care Fraud Report ( 02.28.2007 )
• Speaker, The Scope of Permissable Anti-Kickback Discount Arrangements, American Health Lawyers Association Fraud and Compliance Institute , American Health Lawyers Association , Baltimore, MD (10.06.2014)
• Speaker, Overpayments and Disclosures, Institute on Medicare and Medicaid Payment Issues , American Health Lawyers Association, Baltimore, MD (03.27.2014)
• Panelist, Increased Transparency, Increased Enforcement: Preparing for the Four Most Likely Fraud and Abuse Actions Once the Data is Public, 5th Annual Forum on Sunshine Act Compliance & Aggregate Spend Reporting , American Conference Institute (ACI), New York, NY (10.08.2013)
• Speaker, The Nuts and Bolts of the Sunshine Act and Enforcement Implications, Fraud and Compliance Forum , American Health Lawyers Associaton (AHLA), Baltimore, MD (09.30.2013)
• Speaker, Stark Self-Disclosure, Institute on Medicare and Medicaid Payment Issues , American Health Lawyers Association, Baltimore, MD (03.21.2013)
• Speaker, The Nuts and Bolts of the Sunshine Act and Enforcement Implications , Bloomberg BNA, Webinar (02.27.2013)
• Speaker, Review of Sunshine Act Reporting Regulations, The Nuts and Bolts Of The Sunshine Act Regulation , Massachusetts Medical Device Industry Council (MassMEDIC), Waltham, MA (02.26.2013)
• Speaker, Dealing with Whistleblowers: Lessons Learned & Best Practices, MDMA Compliance Conference , Medical Device Manufacturers Association, Waltham, MA (11.14.2012)
• Speaker, Antikickback and Stark Update, Fraud and Compliance Forum , American Health Lawyers Association and Health Care Compliance Association, Baltimore, MD (10.01.2012)
• Speaker, The Federal Anti-Kickback Law: An Overview, Recent Enforcement Trends and Impact of Healthcare Reform, The Federal Anti-Kickback Law: An Overview, Recent Enforcement Trends and Impact of Healthcare Refor , American Health Lawyers Association, Webinar (03.01.2012)
• Speaker, Anti-Kickback Statute Current Developments, Fraud & Compliance Forum , American Health Lawyers Association and Health Care Compliance Association, Baltimore, MD (09.26.2011)
• Speaker, Medicare and Medicaid Repayments and Self-Disclosures, AHLA Institute on Medicare and Medicaid Payment Issues , AHLA, Baltimore, MD (03.30.2011)
• Speaker, Fraud and Abuse Issues in Off-Labeling Marketing, The A to Z of Off-Label Issues , AdvaMed Medical Technology Learning Institute, Orlando, FL (01.26.2011)
• Panelist, Healthcare Reform's Fraud-Fighting Provision, Fraud and Compliance Forum , AHLA, Baltimore, MD (09.26.2010)
• Moderator, FCA Enforcement Against Pharmaceutical and Device Manufacturers and Health Care Providers, National Institute on the Civil False Claims Act and Qui Tam Enforcement , American Bar Association, Washington, DC (06.03.2010)
• Speaker, Fraud and Abuse Issues in Off-Label Marketing, The A to Z of Off-Label Issues , AdvaMed Medical Technology Learning Institute, Washington, DC (03.30.2010)
• Speaker, Repayments and Disclosures: Legal Requirements and Hard Choices, Institute on Medicare and Medicaid Payment Issues , American Health Lawyers Association, Baltimore, MD (03.25.2010)
• Speaker, Why Your Organization Should Consider an External Review of Its Compliance Program, Legal Issues Affecting Academic Medical Centers and Other Teaching Institutions , American Health Lawyers Association, Washington, DC (01.21.2010)
• Moderator, Prepare for New Federal and State Enforcement as Manufacturer Spending Becomes More Transparent, Physician Payments Disclosure & Aggregate Spend , American Conference Institute (10.01.2009)
• Speaker, Self-Disclosure of Overpayments and Violations of Health Care Laws, Institute on Medicare and Medicaid Payment Issues , American Health Lawyers Association, Baltimore, MD (03.25.2009) (Also at Washington, D.C. Office)