Representative Experience

• Representation of health system in defense of OIG investigation initiated by the OIG consolidated data analysis center
• Representation of mental health service providers responding to joint FBI, IRS, and state Attorney General healthcare fraud investigations
• Representation of physician practice in response to False Claims Act investigation premised on alleged violations of the Anti-Kickback Statute
• Representation of TRICARE provider in federal healthcare fraud investigation into billing and reimbursement practices
• Representation of physician practice groups responding to demands and litigation filed by lab testing organization’s liquidating trustee
• Conduct internal investigation into health system compliance hotline complaints alleging falsification of patient records and other acts of alleged noncompliance
• Conduct analysis of overpayment liability for healthcare providers employing direct-care staff with suspended or restricted licenses
• Defend physician practice groups in audits and demands from MAC and ZPIC auditors evaluating E/M billing
• Representation of hospitals, health systems, and long term care facilities in evaluation and internal investigation of overpayment liability for billing for non-covered services
• Performance of compliance program assessment and recommend adjustments and improvements for multi-specialty physician practice’s compliance program
• Performance of compliance assessment and compliance officer training for medical billing and medical record software development company’s corporate compliance program
• Performance of compliance assessment and follow-on compliance support services for long term care organization’s compliance program

Notable Related Government Experience

• Investigation and prosecution under federal RICO statute of long term care company owner, operators, administrator, director of nursing, and direct-care staff
• Investigation and federal prosecution of both healthcare provider and outside marketing agency for $1.5 million fraud and violations of the Anti-Kickback Statute related to the marketing practices
• Investigation and prosecution utilizing the Health Care Fraud and federal aggravated identity theft statutes in a first-of-its-kind prosecution of a healthcare provider, subsequently upheld by the Fourth Circuit
• Federal prosecution of a home health agency and its owner reported at the time as the largest fraud case against a home health agency in Virginia
• State investigation and prosecution of Medicaid-contracted home and personal care services company owner for utilizing workers without appropriate qualifications and training
• Federal Health Care Fraud investigation and prosecution provider office staff for falsification of prior-authorization criteria
• Federal investigation of healthcare company owner and office staff for alteration of patient records in preparation for an audit leading to prosecution of owner for Health Care Fraud
• State investigation and prosecution of direct-care providers in long term care setting for falsification of patient records
• State investigation and prosecution of long term care business office manager for cost report fraud
• Joint federal False Claims Act and state Fraud Against Taxpayers Act investigation and settlement of cost report fraud committed by a long term care company
• Joint federal False Claims Act and state Fraud Against Taxpayers Act investigation and settlement against dental provider for billing for unnecessary dental services