The prevention of health care program fraud, waste and abuse is a top law enforcement priority. By virtue of extensive government and private sector experience, Dentons is uniquely qualified to help you minimize  the fraud and abuse risks posed by your business arrangements and relationships, and successfully address and resolve government (and whistleblower) audits, investigations, subpoenas, and administrative, civil and criminal litigation.

Our large, talented and experienced team of fraud and abuse professionals furnish services to health care organizations in four principal areas:

• First, Firm lawyers assist you in ensuring that your various business arrangements, contracts, marketing initiatives and investment strategies comply with federal and state anti-kickback, physician self-referral, reassignment, fee-splitting, beneficiary inducement, gainsharing, and related laws and regulations.
• Second, on behalf of providers, suppliers and other health care organizations, Dentons’ lawyers conduct internal investigations, audits and risk assessments of coverage, billing, coding, reimbursement, and documentation practices and procedures.
• Third, our lawyers defend health care organizations in connection with administrative, civil and criminal audits, investigations and litigation, including actions alleging improper coding, billing, pricing and reimbursement, as well as actions involving alleged violations of federal and state anti-kickback, physician self-referral, and related laws and regulations.
• Fourth, drawing on our expertise in the above areas, Dentons’ lawyers develop tailored corporate compliance programs for health care organizations and help implement these programs by providing training and education to compliance officers, in-house counsel, management and billing, coding, reimbursement, marketing and clinical personnel.

Insights

CMS Continues Efforts to Reform Medicare Advantage and Part D Programs with New Proposed Rule

November 16, 2023

United States: The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on November 15, 2023 containing potential revisions to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit (Part D) programs.

CMS proposes further changes to Stark Law regulations: ICA definition and unit-based compensation could be drastically affected

July 21, 2021

In a December 2, 2020 rulemaking (2020 Final Rule), the Centers for Medicare & Medicaid Services (CMS) finalized the most sweeping and significant revisions in over a decade to the regulations implementing the federal physician self-referral statute (Stark Law). The bulk of the new regulations took effect earlier this year on January 19, 2021. CMS is now proposing an additional set of modifications to the Stark Law regulations (Proposed Rule). The proposed modifications are scheduled to be published in the Federal Register on Friday, July 23, 2021, and comments on the Proposed Rule are due on or before Monday, September 23, 2021, at 5:00 p.m. ET. The two most significant changes being proposed relate to the definitions of the terms, “indirect compensation arrangement” (ICA) and “unit-based” compensation.

The Problem of the Square Peg and the Round Hole: When Fee for Service and Managed Care Collide

June 10, 2021

The Stark Law makes little sense in a managed care world and some sense in a purely FFS world. In the new rule, CMS takes its most substantial stab to date at addressing this messy middle by creating three new exceptions for “value-based” arrangements. In this webinar, we unpack their key terms, highlight commonalities and distinctions, and identify the many remaining open questions and issues.

View all insights for Health Care Fraud and Abuse Counseling, Investigations and Defense (United States)