Health Care Is Under Scrutiny. We Will Protect You.
Our firm defended a health care client against a fraud and abuse investigation by the Office of Inspector General. The client's response:
On behalf of myself and M., I would like to extend our gratitude and appreciation for an outstanding job in our presentations regarding the OIG matter. Your honest and thorough work and your belief in our honesty and integrity as physicians, which was conveyed to the OIG and resulted in giving us the opportunity to meet with them, was a smart move and is greatly appreciated.
We truly appreciate all your hard work and representation.
Ben, I would also like to take this opportunity to thank you for finalizing the documents for the purchase of . . . in such a short time.
Thank you both again and have a great weekend.
Health care entities face an increasingly challenging legal environment. From setting up a practice to complying with the Stark Law, fraud and abuse laws, HIPAA and the anti-kickback statutes, following health care laws and defending your organization in investigations are daunting tasks. We can help.
At our law firm Kerr, Hendershot & Cannon, P.C., we have more than 25 years of experience advising, consulting with and representing health care providers and facilities with a wide range of legal needs. As one of the pre-eminent health care law firms in Texas, we provide trusted advice and sophisticated legal representation throughout the state.
Do you need advice on regulatory compliance or issues such as the Anti-Kickback Statute, Stark or HIPAA (Health Insurance Portability and Accountability Act) regulations? Contact us online or call 866-398-1856.
There may be no other industry in the United States that is more stringently regulated than health care. Establishing health care facilities, medical practices, billing practices, high-tech medical equipment purchases, durable medical equipment suppliers, diagnostic centers, physician joint ventures, real estate transactions, physician-hospital relations and most other aspects of the business are bound by some type of regulatory requirement. Any health care entity can benefit from preventing and mitigating potential issues.
With more than 25 years of experience, we are equipped to advise your practice or entity on a wide range of compliance matters.
Medicare and Medicaid Fraud
Our attorneys represent medical professionals and health care facilities in all types of Medicare and Medicaid fraud matters. If you know that you are being investigated for potential fraudulent activity, we will provide the decisive, strategic, aggressive defense representation necessary to protect your interests.
Even if you have been told you are not the target of the investigation, you should contact an attorney. The Office of Inspector General (OIG) and Attorney General's Office (AG) commonly question individuals and businesses before launching an investigation against them. By doing so, investigators can obtain admissions that may lead to you becoming the target of the investigation and can lead to severe consequences, including penalties such as fines, exclusion from Medicaid and Medicare, and other consequences.
We are prepared to represent you in any fraud-related matter, including:
- OIG investigations
- ZPIC (Zone Program Integrity Contractors) audits
- Novitas audits
- Department of State Health Services audits
- False Claims Act violations
- Fraud and Abuse Statute violations
- RAC (Recovery Audit Contractor) audits
- Stark violations
Fraud allegations are serious. We have a strong track record of advising and defending health care professionals and businesses against allegations of fraud. Health care providers of all sizes - from individual physicians to large medical groups - come to us for representation. When millions of dollars are at stake and extreme outcomes are possible, we know how to assist you in resolving these matters.
Your license is your livelihood. Whether you need to obtain a medical license or your license is under investigation, we have the knowledge and experience to advise and represent you.
We represent health care providers of all types in:
- Texas Medical Board hearings
- Peer review and licensure hearings
- Credentialing matters
- Nursing Board issues
- Pharmacy Board matters
We have extensive experience with complaints to the Texas Medical Board and other licensing boards. Your prompt response to requests for information from licensing boards is a critical part of your defense. We will handle every step of the process from the moment you suspect the board is examining your licensure through informal settlement conferences and administrative hearings.
As a professional, you know what's at stake in these matters and that an aggressive defense is required. But when it comes to medical boards, an aggressive defense is not the same as in litigation. We know how to handle these matters before medical boards and administrative bodies.
New Practices, Mergers and Acquisitions
We are able to provide you with guidance at all stages of your medical venture's life cycle. Whether you are creating a new practice, merging with another practice, acquiring another business or in need of more information while considering these potential moves, we can advise and consult with you regarding:
- Corporate compliance
- Management agreements
- Collections from insurance companies
- Billing issues
- Pharmaceutical issues
- Tax exemption
- Employment issues
- Independent diagnostic testing facilities
- Medicare and Medicaid payment issues
- Managed care transactions
If you are considering a joint venture in the medical field, you must meet complex and overlapping health care regulations to ensure that your venture can legally operate. The Stark Law, the anti-kickback statute and its "one purpose test", the Texas Patient Solicitation Act and other regulations can affect whether your deal is legal and how it is structured.
How do you know if these laws apply or whether you meet an exception? We can tell you, and we will advise you on the best way to structure your deal.
We represent investors with compliance in the establishment of:
- Compounding pharmacies
- Physicians' practices
- Medical groups
- Diagnostic centers
- Other health care businesses and facilities
We have experience with joint ventures for high-tech equipment such as CT, CVCT, gamma knives and MRIs.
We will advise you on all aspects of the process of preparing joint venture agreements, from syndication documents to negotiating purchase agreements, lease agreements and management agreements. Our job is to structure your joint venture in a way that allows you to obtain the benefits of working with additional business partners while remaining in compliance with state and federal regulations.
We draft and review physician recruitment agreements that help hospitals and physicians develop productive relationships that are in compliance with Stark and fraud abuse prohibitions. We negotiate, create and assess:
- Physician employment agreements
- Medical director agreements
- Space and equipment leases
- Mobile diagnostic testing agreements
- Management services contracts
- All other types of agreements that medical businesses require
We can also advise you on the impact of compensation agreements, covenants not to compete, confidentiality agreements and nonsolicitation agreements.
We have extensive experience establishing unique compensation plans, buy-in arrangements, bonus structures, exit strategies and buyout formulas. In any situation, our goal is to create a means for you to accommodate growth in your practice or to replace retiring physicians.
Third-Party Payers/Prompt Payment of Claims
Whether from third-party payers or direct payment, medical practices, hospitals and other medical businesses need to receive fair and full payment for services rendered. When this does not occur, you need a powerful advocate help you obtain the funds you are due. We have successfully brought claims in courts and arbitrations to enforce the provisions of the Texas Prompt Payment of Claims Act on behalf of clients and have handled complex collection-related matters involving:
- The collection of principal, fees and, when appropriate, penalties
- ERISA (Employee Retirement Income Security Act) issues
- Assignment of benefits
- Breach of contract
Our experience in this field also allows us to effectively meet your needs regarding managed care issues. From contract drafting, review and negotiation to complex litigation matters involving the interpretation of indemnification provisions, we offer you high-quality legal services in all types of managed care cases.
Call Our Health Care Legal Consultant Team
Contact us online or call 866-398-1856 to speak with a member of our health care legal services team.