Maintaining compliance with federal and state health care regulations can be a challenging task. We can help client teams stay in compliance through the development, implementation, and refinement of the corporate compliance programs necessary to keep their systems running smoothly and in full compliance.

For organizations expanding into additional states, we can provide insights and guidance into each state’s regulations relating to the corporate practice of medicine and fee splitting.

Regulatory Compliance: We maintain strong relationships with state and federal regulators and have an in-depth understanding of the compliance survey process. We can put this knowledge to work for the client, helping clients through the steps necessary to address client professionals’ licensing and other regulatory compliance matters.

As it relates to compliance matters for the larger operation of client health care businesses, we can also provide operational guidance, keeping an eye on the big picture as well as the smallest deadline.

Health care clients turn to us for counsel relating to:

• Certificate of Need
• Facility and professional licensure and certification
• Medicare and Medicaid certification – provider-based status, distinct part units, and hospitals within hospitals
• Organizational policy and accreditation relating to emergency services
• Accreditation – JCAHO, AOA, and other national accreditation agencies

Fraud & Abuse: A growing issue within the health care industry, fraud and abuse claims and compliance issues can be daunting. Greensfelder provides complete legal support for health care providers in this area, including:

• Counseling on state and federal anti-kickback and self-referral laws (Stark Laws)
• Emergency Medical Treatment and Active Labor Act (EMTALA)
• False claims
• Physician recruitment and practice development
• Related regulatory matters

We will work closely with the client to develop strategic legal plans and draft legal opinions and all related documents and agreements to help clients maintain compliance and avoid future claims.

Medicare / Medicaid Compliance & Counseling: We regularly advise clients in their interactions with governmental payors and fiscal intermediaries and have extensive experience assisting with reimbursement issues relating to corporate operations, including:

• Certification
• Provider-based status
• Distinct part units
• Hospitals within hospitals
• Successor liability and change of ownership
• General billing and documentation issues – cost report issues, overpayment issues (including voluntary repayment issues), false claims issues, and administrative review and judicial appeals

Medical Staff & Professional Rights: Managing the rights of professional staff and dealing with medical staffing issues can become tedious, yet highly important, tasks for health care organizations. Clients turn to us for assistance in these situations as well as in matters addressing credentialing and retention issues such as:

• Recommending corrective actions for disruptive or impaired physicians
• Participating in peer review and fair hearing procedures
• Preventing negligent credentialing, negligent reference, or inappropriate economic credentialing claims
• Structuring exclusive provider arrangements
• Providing guidance on reporting requirements for state licensing boards and the National Practitioner Data Bank
• Drafting policies and medical staff bylaws, rules, and regulations

We have extensive experience structuring medical staff committees as peer review committees and advising clients on confidentiality and discoverability of information used in peer review, quality review, and patient safety activities. We have also represented physicians in their relationships with hospitals and in professional disciplinary actions with state licensing agencies.

Investigations: We provide practical, proactive advice in internal compliance investigations, establishing protocols when needed, assisting in the interview process, and documenting the investigation from start to finish.

In the instance of an external investigation, we also represent health care clients throughout the process, providing counsel when an investigation is anticipated, representing the organization through interviews when possible, and guiding the organizational response – both internally and with the public. We can also assist with self-reporting and self-disclosure measures.