Fraud and Abuse

It’s no secret that the health industry is subject to intense government scrutiny. Mintz Levin provides comprehensive counseling and representation to health care organizations throughout the country, to help them comply with health care fraud and abuse laws, including the federal Anti-kickback Statute, the Stark Law, the False Claims Act, and analogous state laws and regulations affecting their business arrangements and relationships.

Mintz Levin regularly represents health care clients under investigation by the Office of Inspector General for the Department of Health and Human Services (OIG), the Department of Justice (DOJ), and state regulatory authorities concerning fraud and abuse matters. We also advise clients on responses to subpoenas, civil investigative demands, and government audits. Mintz Levin has defended health industry clients in connection with allegations of cost report fraud, Stark Law and Anti-kickback Statute violations, claims of upcoding and billing for services not rendered or not medically necessary, criminal patient abuse charges, and unlawful Medicaid rebates.

Our broad-based fraud and abuse experience also includes:

• designing and implementing corporate compliance and training programs, including the development of operating policies and procedures to ensure ongoing compliance with fraud and abuse laws in high-risk areas, such as billing and sales and marketing
• performing internal audits and regulatory reviews of business practices to identify possible compliance failures
• advising clients on the structure of proposed business arrangements and financial relationships, such as acquisitions, joint ventures, affiliations, service transactions, employment relationships, leases, and physician recruitment arrangements
• conducting health care regulatory due diligence reviews for buyers and sellers of health care companies
• counseling clients on the fraud and abuse issues associated with Medicare and Medicaid claims submission and reimbursement, including compliance with state and federal false claims acts and mandatory and voluntary disclosures.

Mintz Levin attorneys offer clients a wealth of past prosecutorial experience. Our litigators know how to navigate the enforcement system and have served in many governmental agencies, including DOJ, OIG, offices of state attorneys general, and Medicaid Fraud Control Units. As a result of our extensive experience handling government investigations, we are able to identify conduct that tends to lead to administrative sanctions or criminal prosecution, and we can assess in a much more informed way the relative risk of a particular arrangement or transaction.