Claim Appeals and Audits: Recovery AuditContractors and Other Medicare/Medicaid Payment Audits
Hospitals We counsel for-profit and not-for-profit hospitals, health systems and academic medical centers across the country on the full range of their operational concerns. Our areas of emphasis include:
Representative Hospital Experience
Physician Groups Our Healthcare Team works with physician groups to structure not-for-profit and for-profit joint ventures and other relationships between and among physicians, physician groups, hospitals, special healthcare service providers and others in the industry. We help form ambulatory surgery centers, general and specialty physician organizations, and MRI diagnostic and imaging centers. Our lawyers are completely familiar with the wide variety of contractual relationships in today's complex health delivery system, including agreements with hospital-based physicians in the areas of pathology, anesthesia and emergency medicine.
We regularly represent physicians, dentists, nurses and other healthcare providers before state regulatory and licensing agencies. As part of our activities in this area we negotiate consent decrees and settlement releases, conduct confidential investigations to determine liability and appropriate defenses, submit applications to practice in multiple state jurisdictions, and ensure compliance with regulatory obligations and state laws. Specific experience includes:
Regulatory As the healthcare industry continues to see unprecedented regulation and even criminalization of activity, Baker Hostetler helps clients minimize the legal risks in regulatory compliance activities, including fraud and abuse, Stark, EMTALA and false claims compliance. We work with boards, management compliance committees and officers on the changing needs and requirements of providers and others in the industry. We help clients establish corporate compliance programs tailored to their specific organization and assist corporate compliance officers in implementing compliance programs.
We guide clients through audits by the Office of Inspector General and the Centers for Medicare and Medicaid Services. Some of the areas in which we have counseled healthcare providers include coding and billing issues; Medicare pass-through coding, ICD9-CM coding, hospital revenue and condition coding; state-level regulatory matters, including licensure and certificates of need; and the Medicare outpatient prospective payment system, compliance, and prohibition against unbundling of hospital outpatient services.
In the event of criminal actions we can negotiate plea agreements, reducing charges and dealing with adverse publicity. We strive to minimize fines, penalties and sanctions and are skilled in negotiation of consent decrees, settlement agreements and releases.
Healthcare-Related SuppliersOur lawyers advise a variety of manufacturers and distributors of medical devices, pharmaceuticals and providers of other products and services to healthcare providers. We represent national and international producers and distributors of pharmaceuticals in connection with product distribution, group purchasing organization agreements, manufacturer representation agreements and product liability matters.
Cardinal Health, Inc.
Texas Children's Hospital
The Health Alliance of Greater Cincinnati
The Health Plan of the Upper Ohio Valley
Medical Imaging Professionals, Inc.