The legislation governing fraud and abuse is constantly changing and evolving, due to the need on the payors? part to both combat health care fraud and reduce costs by erecting significant regulatory hurdles for health care providers and developing new, and ever-changing, professional relationships and organizational structures. The volatile nature of fraud and abuse law demands the constant and ongoing review of relationships and structures in order to ensure that new fraud and abuse legislation is not overlooked and subsequently violated by virtue of oversight.

Recent years have seen the rise of large scale, multi-defendant lawsuits by various insurance carriers seeking to recover monies paid to legitimate health-care providers on the basis of, among other things, an alleged ?illegal corporate structure?. Our attorneys have been amongst the lead counsel who have successfully defended virtually all of these suits on behalf of respective clients in both the state and federal courts. We have also been prominent in resolving these matters with the requisite degree of confidentiality, in order to contain them within their particular civil venue.

Additionally, we have successfully brought and/or defended numerous commercial arbitrations and other proceedings involving recovery of fees due to physicians, dentists, podiatrists and other health-care providers from several third-party insurance carriers.

Many of our attorneys regularly participate in the audit process in matters involving the recovery of Medicare and/or Medicaid fees, and have both negotiated settlements thereof and conducted administrative hearings before the New York State Department of Health (?DOH?) (Medicaid) and the Centers for Medicare and Medicaid Services (?CMS?) (Medicare). These same attorneys have also defended various providers in Civil Monetary Actions (?CMP?s) brought by the Office of the Inspector General (?OIG?) of the United States Department of Health and Human Services (?HHS?) seeking monetary recovery of fees on the basis of allegations involving violations of the Federal Anti-Kickback Statute and the Physician Self-Referral (?Stark?) Law.

We have also been instrumental in the interposition of various provider-favorable provisions of the New York State Public Health Law against the carriers?in particular, Section 4406-d, which section, in Foong v. Empire Blue Cross and Blue Shield, our attorneys successfully argued provided for a private right of action by a physician whose contract with a health maintenance organization (?HMO?) is improperly terminated by the HMO on the ground of alleged fraud.

The firm?s attorneys lecture on (including on behalf of the NYS Bar Association Health Law Committee), represent and advise clients with regard to actions concerning prohibited and restricted referrals, anti-kickback safe harbors, and billing and fee splitting statutes and regulations. The firm employs its expertise in these areas to advise on and negotiate agreements for health care professionals and groups in structuring their practices and ancillary service arrangements and physician-hospital employment, joint venture and independent contractor relationships, including:

• Audits performed on existing contracts and financial relationships
• Legal plans for the acquisition of practices or facilities
• Preparation of legal opinions concerning new financial relationships
• Reviews of financial offerings and the policies and procedures concerning billing operations.