Regulatory, Reimbursement and Compliance

Health care providers do business within a complex web of interlocking and overlapping local, state and federal regulations. What makes good business sense in almost any other industry may actually be illegal in health care.

Jackson Walker attorneys help our clients negotiate this ever-expanding web of regulations, to help them succeed in providing innovative, quality healthcare services in a cost-effective and financially productive manner.

Our attorneys analyze state and federal regulatory issues affecting health care providers and related entities, including:

Federal

• Fraud and abuse laws, including Stark, Anti-kickback and False Claims


• EMTALA


• Advise clients on Antitrust matters, including representation before the Federal Trade Commission and Department of Justice


• CLIA


• Medicare and Medicaid reimbursement and billing issues, including PPS and fee schedule programs


• Represent clients charged with Medicare or Medicaid fraud and abuse


• Assist in preparing and implementing corporate compliance programs


• Reimbursement disputes before the Medicare Provider Reimbursement Review Board, state Medicaid agencies, and in state and federal court


• Resolve regulatory and legislative issues with the CMS, OIG, NIH, and Congress


• HIPAA compliance


• IRS compliance and reporting for taxable and tax exempt organizations

State

Represent providers with State (Texas) licensing boards, including the Department of State Health Services, Department of Aging and Disability Services, Texas Medical Board, Texas Board of Nursing, and the Texas State Board of Pharmacy

Corporate practice of medicine compliance

State law disclosure issues in private placements and public offerings.

Department of Insurance prompt pay and other provider contracting and payment issues

State anti-kickback and False Claims laws

State Comptroller taxation issues