Fraud and Abuse

Health Care Providers face significant regulatory hurdles as payors attempt to combat health care fraud and abuse. Additionally, federal and state regulatory agencies have enacted several laws designed to verify the providing of quality of care, and to increase reporting, investigation, disciplinary and prosecution of those who commit or assist insurance fraud. In response, medical entities must work to structure their practice policies and procedures and participations in health care ventures to ensure that these laws are not violated.

Burnham Brown attorneys have counseled health care providers and businesses across the country in managing these ever changing laws, regulations and medical ethics issues. Some of their effective legal work has included the following:

  • Provided legal opinions regarding financial relationships with ancillary providers, physician participation in drug research programs, home health service providers, and integrated health delivery systems.
  • Provided advice and counsel concerning joint venture arrangements, marketing compensation arrangements, and provider practice percentage arrangements.
  • Represented clients who were the subject of federal and state regulatory agency inquiries.
  • Developed investment documents, leases, management contracts, service and consulting contracts subject to fraud and abuse laws.
  • Client representation in health litigation relating to unfair trade practice and improper patient transfer claims.
  • Research and drafted strategic law plans for development of managed care organizations.

 

Health Care Providers face significant regulatory hurdles as payors attempt to combat health care fraud and abuse. Additionally, federal and state regulatory agencies have enacted several laws designed to verify the providing of quality of care, and to increase reporting, investigation, disciplinary and prosecution of those who commit or assist insurance fraud. In response, medical entities must work to structure their practice policies and procedures and participations in health care ventures to ensure that these laws are not violated.

Burnham Brown attorneys have counseled health care providers and businesses across the country in managing these ever changing laws, regulations and medical ethics issues. Some of their effective legal work has included the following:

  • Provided legal opinions regarding financial relationships with ancillary providers, physician participation in drug research programs, home health service providers, and integrated health delivery systems.
  • Provided advice and counsel concerning joint venture arrangements, marketing compensation arrangements, and provider practice percentage arrangements.
  • Represented clients who were the subject of federal and state regulatory agency inquiries.
  • Developed investment documents, leases, management contracts, service and consulting contracts subject to fraud and abuse laws.
  • Client representation in health litigation relating to unfair trade practice and improper patient transfer claims.
  • Research and drafted strategic law plans for development of managed care organizations.

 

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