The Pannone Lopes Devereaux & West LLC health care team consists of experienced litigators and health care, employment and corporate practitioners who combine their expertise to represent and assist their clients in the health care industry.

Lawyers Handling Issues Involving Health Care Fraud and Abuse

The health care industry is a mine field of rules and regulations, all of which present potential liability to the provider, including:

• The Anti-Kickback Statute
• The Stark Law
• The False Claims Act
• The qui tam whistleblower statute
• Health Insurance Portability and Accountability Act (HIPAA) privacy and security provisions
• The Fraud Enforcement and Recovery Act
• The Patient Protection and Affordable Care Act

• Corresponding state laws

The PLDW health care team is experienced in dealing with the Department of Justice, the Health and Human Services Office of the Inspector General (OIG) and Office of Civil Rights, Medicare fiscal intermediaries, state prosecutors and Medicaid agencies in defending against enforcement actions, health care fraud criminal charges, investigations, agency audits and repayment demands.

Our health care attorneys are highly skilled in developing effective strategies to address criminal charges and civil allegations. They also have the experience to identify and effectively employ Safe Harbor regulations, obtain OIG advisory opinions, or negotiate a Corporate Integrity Agreement or Deferred Prosecution Agreement that is in the client's best interest.

PLDW attorneys successfully negotiated one of the nation's few Deferred Prosecution Agreements implemented in a health care setting. Our attorneys are experienced in developing defenses to enforcement actions that may result from:

• Cost reporting, billing and coding issues
• Upcoding and unbundling issues
• Self-referral issues; recruitment
• Referral arrangements
• Joint ventures involving leasing of equipment or laboratory facilities
• Physician practice acquisitions
• Marketing; medical device and durable medical equipment (DME) issues
• Pharmacy reimbursement issues related to generics and substitution
• HIPAA violations
• Alleged violations of the Honest Services Doctrine

Labor and Employment

Health care providers are among the most labor-intensive of employers, and they face a unique combination of labor and employment concerns. Providers are often unionized and governed by Employee Retirement Income Security Act (ERISA) benefits plans, which in turn are often self-insured. Health care-specific concerns such as HIPAA, state privacy laws and patient-safety laws add another level of complexity not found among other employers.

The recent Patient Protection and Affordable Care Act contains numerous provisions related to employee benefits plans. PLDW assists employers in analyzing the effects of retaining a grandfathered plan, understanding the requirements of non-grandfathered plans, and structuring new plans that comply with both evolving law and existing bargaining agreements.

PLDW's health care team is highly experienced in advising and representing the full spectrum of health care employers. PLDW frequently represents employers in labor mediations, as well as before the Occupational Safety and Health Administration (OSHA), the Equal Employment Opportunity Commission (EEOC), the Massachusetts Commission Against Discrimination, the Rhode Island Commission for Human Rights, and federal and state courts.

Bankruptcy, Receivership and Creditors' Rights

PLDW assists challenged health care institutions in capitalizing upon the most advantageous strategies available under bankruptcy and receivership law. Medicare and Medicaid regulations make health care provider bankruptcy and receivership unique among industries and dramatically impact the normal rules regarding debtors' and creditors' rights; even the choice of which court to file in holds unique considerations for a health care institution facing bankruptcy. PLDW works with both debtors and creditors to maximize their rights in a health care bankruptcy, receivership or restructuring.

Litigation and Other Contested Matters

The PLDW litigation team represents clients in a broad spectrum of contested matters, ranging from civil litigation to agency and administrative determinations. The complexities faced by health care organizations often lead to disputes with vendors, partners, medical staff and others. PLDW's familiarity with the health care industry allows us to often resolve disputes without damaging the underlying relationships that are critical to the clients' ongoing operations.

PLDW also represents health care clients before governmental agencies, including Provider Reimbursement Review Board appeals and appearances before administrative law judges. In addition, our experienced attorneys, represent clients on either side of applications for Certificates/Determinations of Need and HIPAA violation defense that can jeopardize JCAHO (Joint Commission on the Accreditation of Healthcare Organizations) accreditation and insurance malpractice premiums. PLDW recently represented a hospital in successfully opposing an application for a major service expansion submitted to a state regulatory agency by one of New England's largest health care systems.

At PDLW, we also handle issues concerning health care corporate governance, regulatory compliance and health care reform.

For more information and a consultation with a lawyer, contact our firm.