Government and Payor Audits and Investigations
Today’s health care and service providers face an unprecedented number of governmental and third party payor audits and investigations. As state and federal government and private payors attempt to combat fraud and abuse and contain health care costs, they have increased the frequency and intensity of audits and investigations. Health care providers must now routinely defend themselves in administrative audits and civil and criminal investigations, often managing such audits and investigations at the same time. Providers risk reimbursement withholds, high dollar repayments, and in the worst scenarios, potential exclusion from reimbursement programs.
Providers undergoing an audit or investigation need a highly skilled and experienced law firm capable of understanding complex corporate health structures and relationships, as well as intricate state and federal reimbursement requirements. Our firm’s broad knowledge of health care licensure, finance, reimbursement and delivery makes us ideally suited to meet that need. Damon Morey provides complete legal support to providers throughout all phases of the audit, investigation and dispute resolution process.
Our extensive experience representing providers involves a wide array of regulatory and prosecutorial bodies, including the Centers for Medicare and Medicaid Services, the Office of Inspector General of Health and Human Services, the United States Attorney’s offices, the United States Department of Justice, the New York State Office of Medicaid Inspector General, Medicaid Fraud Control Unit, and Attorney General’s Office. Our attorneys also handle audits and investigations initiated by the Federal Food and Drug Administration, the Federal Trade Commission, and the Internal Revenue Service.
We counsel all types of providers, suppliers and investors regarding internal investigations, voluntary self-disclosures and corrective action plans. Our attorneys often work with management teams, boards of directors and audit committees to develop strategies to minimize risks to the organization.
We have designed and developed compliance initiatives and programs for a wide variety of clients in the health care industry. We encourage our clients to carefully evaluate routine and complex matters, with the ultimate goal of proactive risk management.