A Healthcare Overview: Smith Pauley Law
By Natalya Bull, Attorney, Smith Pauley LLP
Smith Pauley counsels healthcare clients on a wide range of legal matters, including medical claim reimbursement, fraud and abuse analysis, regulatory compliance, and healthcare transactions.
We help healthcare providers maximize their revenue by appealing improper recoupment actions brought by CMS contractors and removing providers from pre-payment reviews. In addition, we provide fraud and abuse counsel, including analysis of the Anti-Kickback Statute, the False Claims Act, the Stark Law, and Eliminating Kickbacks In Recovery Act (EKRA), as well as regulatory compliance with HIPAA and the corporate practice of medicine. We similarly assist pharmaceutical and medical device companies with navigating the FDA regulatory process. Finally, Smith Pauley represents clients in complex healthcare transactions, including mergers and acquisitions, corporate finance, general corporate counseling, venture capital and capital formation transactions, commercial contracts, and real estate.
GAP Analyses
At Smith Pauley, we have extensive experience conducting audits ("GAP analyses") of healthcare practices' medical documentation and claims submission processes, with the goal of minimizing future claim denials and recoupment actions by identifying and correcting deficiencies in the medical documentation and/or claim submission process. Our attorneys are also Certified Profession Coders (CPC) and intimately familiar with the coding and billing process.
Regulatory Compliance
In addition, we provide detailed audits of healthcare practice's operating and data privacy policies to assess the extent to which they comply with HIPAA and fraud and abuse laws. If we identify areas of non-compliance, we provide timely corrective action, including the creation of effective compliance plans, reformation of internal policies and procedures, and staff compliance training.
Our healthcare practice group has counseled a diverse range of healthcare providers on a wide range of regulatory and compliance matters. We have:
Structured a collaborative services agreement between medical spa and the licensed physician to enable licensed aestheticians to provide laser hair removal, chemical peels, and cool-sculpting services under a physician’s supervision.
Assisted optometrist with the purchase and transfer of optometry and ophthalmology practice.
Conducted complex analysis to evaluate hospital system's protocol for discharging patients against medical device and advised client about best practices to avoid legal liability.
Assisted independent clinical laboratory with reorganizing its ownership structure to ensure compliance with the corporate practice of medicine doctrine; advised laboratory about structuring compensation and bonus arrangements which complied with EKRA, the Stark Law, and the Anti-Kickback Statute; Assisted laboratory with drafting standing physician authorization forms which complied with fraud and abuse laws.
Developed creative legal arguments to successfully represent healthcare providers in complex reimbursement disputes; conducted substantive analyses of client medical records to demonstrate that the patient met the medical necessity threshold.
Disputed improper overpayment assessments and pre-payment reviews before CMS contractors and private payors, and, when necessary, filed appeals with state and federal agencies.
Advised clients about optimal medical billing, coding and claim submission practices to minimize the rate of claim denials and to help clients avoid future audits, reviews, and investigations.
Assisted healthcare clients with designing protocols to proactively identify and remedy vulnerabilities in their business operations before problems arose.