Compliance
Creating and maintaining effective compliance programs that meet state and federal guidelines is of critical importance. Complex regulations affect every aspect of health care practice, including licensure, billing and collections, fraud and abuse, and HIPAA privacy requirements, to name a few. Carmody & Torrance health care attorneys provide sound, experienced and practical advice regarding comprehensive compliance programs.
Government investigations by both state and federal agencies are rising dramatically. We provide experienced legal counsel to assist clients through the entire investigation process, including representation of the client before state professional licensing bodies, Medicare / Medicaid, the United States Office of Civil Rights (HIPAA), the Office of Inspector General (Fraud and Abuse), fiscal intermediaries, the Department of Justice and other government agencies.
Carmody & Torrance has assisted health care clients with all aspects of HIPAA compliance and provides representation against HIPAA-related charges or allegations.
In advising health care clients regarding compliance and regulatory matters, Carmody & Torrance is able to offer clients the expertise of corporate attorneys as well as litigators experienced in defending providers under regulatory scrutiny. Using this approach, Carmody & Torrance is not only able to offer clients advice on the development of compliance strategies, but also can provide skilled and effective defense when, despite the provider’s compliance efforts, an administrative, civil, or criminal investigation begins.
Representative matters include:
- Representing a major home health agency in a state licensing and reimbursement investigation and audit.
- Providing legal advice and drafting of agreements and forms in relation to a community hospital’s transition to a fully electronic health records.
- Representing a nursing home facility in federal appeal of DPH/CMS survey and licensure action.
- Assisting a health care facility with an internal audit and analysis of self-disclosure issues.
Regulatory
Carmody & Torrance provides sound, experienced advice in all matters concerning credentialing and hospital physician relationships, including credentialing policies and procedures, staff privileges disputes, exclusive service agreements, peer review matters and issues involving competition among providers.
Carmody & Torrance regularly advises its health care clients regarding analysis of and revisions to their bylaws, rules/regulations and other governance documents and procedures.
Representative matters include:
- Complete review and update of credentialing / privileging procedures and processes at a large community hospital.
- Restructuring of a hospital’s peer review processes, including revised committee structures, modifications to bylaws and development of policies.