Healthcare Regulatory and Compliance Practice Group

The Huff Powell Bailey – Regulatory Team (HPB-RT) brings over 40 years of first-hand knowledge and practical hands-on experience from the perspective of the client and its needs. The team can bring guidance and support in the following areas:

• Deep knowledge of the complex regulatory framework of the health care industry
• Educational materials and tools to support clients in the health care industry
• Policies and procedures for providers in key areas
• Insight and experience with internal and government investigations

This experience, as well as various tools and programs described below, will enhance the operations, and reduce regulatory hurdles for providers.

Practice Group Leader

David Mackenzie

COMPLEX REGULATORY FRAMEWORK

The health care industry is complex and highly regulated. The HPB-RT can assist providers across the industry through a number of services and offerings, such as:

Audits and Recoupments

• Attempts by Medicare, Medicaid, private insurers, and contractors to hold or recoup funds for services
• Appeals and arguments before Administrative Law Judges (ALJs)
• Advice and guidance regarding overpayments and voluntary disclosure

Government Investigations and Civil Investigative Demands

• Assistance with Federal and State government investigations
• Assistance with Civil Investigative Demands, subpoenas and documentation requests
• Assistance with and response to Qui Tam and False Claims Act actions

State Board Investigations and Individual Licensure Actions

• Representation of licensed professionals before licensure boards
• Assistance with Peer Review matters
• Responses to private insurer investigations and complaints

Post-Acute and Senior Living 

• Legal advice and guidance regarding survey and enforcement actions
• Legal advice and assistance with investigations of abuse, neglect and/or exploitation of patients/residents
• Assistance with the involuntary discharge process
• Advice regarding privacy matters under HIPAA and state privacy laws/regulations
• Assistance with development and implementation of Emergency Preparedness Plans.

Compliance Program Development and On-going Support

• Assistance with set up and organization of Compliance Committees
• Compliance policy and procedure development
• Compliance education and training
• Implementation and maintenance of Corporate Integrity Agreements

Change of Ownership/Facility Closure

• Assistance with all aspects of changes of ownership, including licensure and Medicare and Medicaid certification and recertifications
• Negotiation of Operations and Management Transfer Agreements
• Assistance with transparency disclosures under the new Transparency Regulations
• Assistance with facility closures (voluntary or involuntary)

Certificate of Need

• Assistance with development and completion of certificate of need applications for new services or changes to existing services
• Assistance with challenges to certificate of need applications

Education and Training 

• The new CHOW regulations
• The new Transparency Regulations
• Emergency Preparedness
• General Investigations
• The Governing Body and other governance requirements
• Elder Justice Act