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Health Care Compliance, Fraud & Abuse, Regulation & Policy

Healthcare compliance affects all healthcare providers regardless of size or type. Healthcare is one of the most highly regulated industries, with state and federal laws and regulations that govern nearly every aspect of a healthcare provider's business: permitted ownership structures for healthcare facilities, prohibitions on self-referrals, patient safety and quality of care, privacy and security of patient information, and billing practices and reimbursement matters, to name a few. Legal oversight of healthcare providers is an ever-changing arena with new laws, regulations, and standards issued on a continuous basis. Healthcare providers must be continuously diligent in their compliance efforts.

The stakes for noncompliance are high, including staggering fines, loss of licensure, loss of Medicare or Medicaid enrollment and other payor matters, lawsuits, whistleblower actions, and, in some instances, even criminal penalties. Having experienced healthcare counsel is essential for any successful healthcare provider.

The attorneys at MacDonald Illig have a sophisticated healthcare practice, representing providers of all sizes and types. Our healthcare group regularly advises clients regarding patient privacy and medical records issues. We assist with all aspects of HIPAA compliance, from initial risk assessments, preparation of policies and procedures, and employee training, to conducting breach risk analyses and guiding clients through breach reporting requirements. We help clients structure potential transactions or business arrangements to comply with the Stark Law, which prohibits physician referrals to an entity in which the physician or a family member has a financial interest, and the Anti-Kickback Law, which prohibits providing or soliciting anything of value in exchange for a referral, among other healthcare laws. In the event our clients experience a claim or lawsuit, our experienced litigators team up with our healthcare attorneys to provide a knowledgeable and zealous defense.

MacDonald Illig attorneys have expertise in the following areas of healthcare compliance, among others:

  • Social Security Act, Medicare, Medicaid and other payor and billing matters
  • HIPAA and HITECH Act
  • False Claims Act, including qui tam (Whistleblower) litigation
  • Stark Law (Physician Self-Referral) compliance and defense
  • Anti-Kickback Law compliance and defense
  • Self-Reporting Obligations
  • Patient Protection and Affordable Care Act
  • Drug Enforcement Administration issues
  • Implementation of compliance initiatives and programs
  • Employee Training
  • Policies and Procedures
  • Licensure matters