Health Care & Regulated Industries
Health care and other regulated industries require a deep understanding of complex rules and regulations. Our attorneys have experience helping clients navigate their obligations under these rules, as well as working with regulators to allow clients to implement strategies that benefit all parties involved. Our attorneys have practical experience as well, with two of our attorneys serving in-house with hospitals at times in their careers. Whether representing hospitals, physician groups, insurance companies, registered advisors or other regulated industries, Gilpin Givhan has the sophistication and experience to help clients develop and manage operations so they can focus on providing services as opposed to constantly responding to regulatory concerns.
The Health Care and Regulated Industries practice group’s particular areas of expertise include:
Regulatory Compliance>
The firm routinely advises clients in connection with regulatory compliance matters, including investigations and enforcement proceedings initiated by various federal and state agencies. We work with our clients to develop compliance programs tailored to each client’s needs, and we assist clients with various compliance issues, including the following:
- Federal and State Fraud and Abuse Laws (Anti-Kickback Statute, Stark/Physician Self-Referral Law, etc.)
- Health care Quality Improvement Act
- Patient consent issues
- End–of–life issues
- Emergency Medical Treatment and Active Labor Act (EMTALA)
- Health Insurance Portability and Accountability Act (HIPAA)
- False Claims Act
- Medicare and Medicaid participation issues
- HITECH Act readiness and compliance
- State health planning and Certificates of Need.
Billing and Reimbursement>
Billing and reimbursement disputes with federal and state programs can be complex and difficult. Our Health Care practice group has experience handling disputes with the full spectrum of payer organizations, including Medicare, Medicaid, TRICARE, CHIP, and a host of private payers. We represent and help our health care clients in working through a number of audit issues, including MICs, ZPICs and RACs with insurance companies, third-party administrators, and Medicare and Medicaid intermediaries.