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Corporate and Regulatory Compliance

Corporate and Regulatory Compliance


Overview

In this time of unprecedented scrutiny of health care providers and record-breaking civil and criminal recoveries, it is critical that providers develop a strong relationship with compliance counsel who has the experience and knowledge to help design effective compliance programs, conduct thoughtful risk assessments, and provide practical solutions to identified compliance concerns. Our compliance team is made up of health care attorneys having regulatory, civil litigation, and white collar criminal defense experience, including attorneys with backgrounds in nursing, clinical research, and accounting and statistics. We bring these practical skills to bear for our clients in every engagement.

Although we have extensive experience in crisis situations, we believe our clients benefit the most from our practical advice and assistance in creating everyday compliance solutions and ensuring that our clients' operations comply with the myriad of statutes and regulations to which they are subject.  In reviewing and creating contracts, policies and procedures, and business strategies, we focus on preventing violations of the law before they occur and limiting exposure to civil and criminal sanctions while taking into account patient care and operational considerations.  We work hard to develop an understanding of our clients' operations as a whole, and we know from experience that compliance solutions have to be cost-efficient and tailored for the institution's culture and resources in order to be effective.

We also focus on developing practical tools to assist our clients in their compliance activities.  From the development of the S.i.M.P.L.E. Section 111 reporting software to template forms and policies and packaged compliance consulting services, we strive to be an essential member of our clients' compliance teams.

Whether you are facing an investigation or audit or you are seeking guidance to ensure compliant practices and a better understanding of the wide range of laws and regulations governing health care, Smith Moore Leatherwood's compliance team has the skills and resources you need.

Experience
  • Developed corporate compliance plans, policies, and procedures for a range of providers and suppliers, including medical billing companies, critical access hospitals, multi-specialty physician practices, and skilled nursing facilities
  • Deployed an "EMTALA Crisis Team" to hospital facing "third-strike" termination of Medicare participation to conduct on-site training of staff, revision of policies and procedures, a process flow analysis, negotiations with surveyors, and real-time review of physician documentation to ensure compliance with EMTALA transfer requirements
  • Conducted internal audits and investigations on behalf of clients to assess risk and evaluate whether identified physician order entry and documentation issues constituted a reportable compliance violation
  • Presented tailored education sessions to physicians, nursing staff, and Board members on compliance risk areas
  • Assisted clients in responding to 340B audit requests and in conducting internal investigation into suspected non-compliance with 340B contract pharmacy requirements
  • Prepared responses to Office of Civil Rights (OCR) complaints alleging non-compliance with limited English proficiency regulations and requirements, assistive aids for the hearing impaired, and other issues
  • Assisted with Medicare and Medicaid enrollment issues
  • Conducted detailed analyses of applicable Medicare conditions of payment and conditions of participation and CPT code descriptors to identify applicable billing requirements and assess whether overpayments were received
  • Advised clients concerning Medicare Secondary Payor and Section 111 requirements
  • Conducted compliance exit interviews for senior staff of provider organizations
  • Provided advice regarding properly structured and administered ERISA plans involving physicians
  • Prepared responses to state agencies charged with protecting the rights of persons with disabilities
  • Supervised and provided legal analysis of compliance audits by outside consultants
  • Conducted audits of physician contracting practices to identify potential violations and areas for improvement
  • Provided advice regarding graduate medical education funding and expansion of residency programs
  • Assisted clients in responding to requests for information and formal and informal inquiries from State attorneys general
Thought Leadership

Publications

January 27, 2017
January 10, 2017
Life After Obamacare – Part III, Health Care Law Note
November 29, 2016
Life After Obamacare – Part II, Health Care Law Note
November 14, 2016
Life After Obamacare – Part I, Health Care Law Note
February 16, 2016
February 15, 2016
ACO Compliance Considerations, Health Care Law Note
September 21, 2015
November 2008
2009 CMS MPFS Final Rule - IDTFs, Health Care Law Note
October 2008
March 2008
DISCLAIMER

Each of our lawyer's e-mail address is provided with his or her biography. If you are not a current client of our firm, you should not e-mail our lawyers with any confidential information or any information about a specific legal matter, given that our firm may presently represent persons or companies who have interests that are adverse to you. If you are not a current client and you e-mail any lawyer in our firm, you do so without any expectation of confidentiality. We will not establish a professional relationship with you via e-mail. Instead, you should contact our firm by telephone so that we can determine whether we are in a position to consult with you about any legal matters before you share any confidential or sensitive information with us.