Regulatory Compliance and Governmental Relations

Gjerset & Lorenz attorneys understand the nuances of the highly regulated healthcare industry. Regulatory issues arise for our health care provider clients in a wide range of contexts, including, ongoing operations, reimbursement and business transactions. We monitor state and federal legislative, administrative initiatives and judicial decisions to better equip us to advise our clients regarding the affect of these actions on their businesses. We provide proactive representation to minimize the risk of potentially ruinous federal and state enforcement actions and to provide our clients the legal information they need to make these day-to-day business decisions.

Our proactive representation includes advising clients in the development of policies, procedures and quality assurance programs designed to ensure compliance with laws, state and federal regulations, governmental and fiscal intermediary interpretations and conditions of participation, including:

• Fulfillment of non-profit community benefit and charity obligations
• Patient Transfer/EMTALA
• Patient admission and discharge requirements
• Federal and state anti-kickback and fraud and abuse laws
• Federal and state self-referral and Stark laws
• Medicare conditions of participation, billing and payment
• Bad debt collection policies
• State Medicaid contracting, reimbursement and funding
• HIPAA
• JCAHO
• Peer Review
• Charity Care policies
• Trauma funding
• Medicaid and Medicare Disproportionate Share Hospital funding

Federal and state governments’ health care fraud enforcement activities continue to grow. Gjerset & Lorenz attorneys strive to provide clients a clear picture of the risk continuum associated with various business ideas to enable them to make a fully informed decision. We serve as zealous advocates in the event that an enforcement action is taken against a client. We represent health care provider clients facing federal and state investigations, qui tam, licensure and administrative penalty actions and private litigation related to enforcement initiatives undertaken by federal and state agencies, including actions alleging violations of:

• State and federal False Claims Act
• Anti-Kickback laws
• Stark laws
• Antitrust laws
• Abuse and Neglect laws
• Reimbursement regulations
• Conditions of Participation

Gjerset & Lorenz attorneys have successfully defended investigations by the government in connection with each of the above allegations. We have also represented provider clients in Office of Inspector General (OIG) and Department of Justice (DOJ) investigations and interpretations of OIG and DOJ enforcement actions.