Fraud and Abuse
Fraud and abuse issues are among the most serious and difficult issues on the health care landscape, and many providers and other persons are under the mistaken belief that these issues arise only if Medicare or Medicaid (Medi-Cal in California) patients are involved.
The federal anti-fraud and abuse statute, as well as the related safe harbor rules that protect certain types of arrangements from challenge, are complex and require careful analysis when applicable. We have extensive experience interpreting this law, the safe harbor rules, and related court decisions and advisory opinions, and structuring transactions to avoid regulatory prohibitions. These issues often arise along with Stark issues, discussed under self-referral laws in the PRACTICE AREAS addressed in this website. Whether or not a given project involves the provision of care to governmentally funded patients, various state law issues arise where remuneration or other financial issues exist, including issues under California’s well-known Business and Professions Code Section 650. Penalties under this provision can be severe, and other laws may be implicated, as well. We have a great deal of experience with these and related regulatory issues. See self-referral laws, corporate practice of medicine, and fee-splitting discussed in the PRACTICE AREAS addressed in this website.
Among other things, we frequently provide our clients with advice letters, including do’s and don’t’s, to provide guidance on how to avoid the pitfalls that these various laws present.