Stark, HIPAA & Other Specialty Pages
Be sure to visit our Stark Law/Fraud and Abuse specialty page and our HIPAA specialty page for background information, Web links, and the latest developments in these two important areas of health law.
Anesthesia and Pain:
WACHLER & ASSOCIATES, P.C. specializes in health care law with specific expertise in the issues surrounding the provision and billing requirements for anesthesia and chronic pain management services. Our firm has worked on the development and implementation of numerous anesthesia and pain management specific compliance programs for groups of all sizes across the country. We continue to provide counseling to anesthesia and pain management groups relative to maintaining the effectiveness of their compliance programs. We also work with billing companies that specialize in anesthesia and pain management billing with regard to billing compliance and contract matters. In addition to working with anesthesia groups on compliance, we regularly counsel and represent anesthesia and pain management groups with regard to contracting matters, audit defense, staff privilege matters and other health care matters.
Attorney Andrew Wachler regularly speaks and writes on anesthesia and pain management health care law topics.
Third Party Payor Audit:
WACHLER & ASSOCIATES, P.C. specializes in health care law with specific expertise in representing all types of health care providers and suppliers in the defense of third party payor audits. The firm has defended over 1,000 Medicare, Medicaid and Blue Cross Blue Shield Audits. We represent clients in all stages of the audit process including the pre-audit stage and hearing phase.
As many providers may be aware, claims for medical services may be audited by payors for a number of reasons. Some audits are a result of random selection or some result from data analysis that reflects that the group is outside the norm among its peers in the provision of services. Audits may also arise from complaints by individuals including patients, disgruntled employees, and competitors about the group's billing practices. Audits can also take place due to a payor's initiation of certain code specific or service specific audits for all groups who provide such services. Regardless of the initial reason for the audit, once the audit process is in place, the provider is likely to be dissatisfied with the results. Due to the negative consequences that often follow an audit, it is very important for providers to appeal the audit results in conformance with the applicable appeals process. Failure to do so can lead to large monetary paybacks, continuing problems with the ongoing submission of claims, re-audits, placement on pre-payment utilization review, suspension of Medicare payments, or termination/disaffiliation from payor programs. Although many providers who receive audit results requesting small monetary payback amounts do not believe that it is necessary to exercise the appeals process, in many circumstances, it is in the best interest of the provider to appeal as the provider can continue to face problems with future claim submissions and re-audits.
Ambulatory Surgery Centers:
WACHLER & ASSOCIATES, P.C. has specific expertise in counseling and representing ASC clients, in all aspects of health care law, including: (a) fraud and abuse; (b) billing and compliance issues; (c) third party payor audits; (d) corporate formation; (e) CON; (f) licensure and certification; (g) HIPAA privacy and security; and (h) other health care legal matters.
Our attorneys have extensive experience counseling clients on legal issues associated with the development, acquisition, and operation of ASCs, including advising clients on structures and governance documents which comply with the Federal anti-kickback safe harbors. Attorneys at WACHLER & ASSOCIATES, P.C. also counsel ASC clients on a regular basis regarding HIPAA privacy and security issues and have authored a HIPAA privacy and security manual specific to the ASC market for the Federated Ambulatory Surgery Association (FASA). Attorney Andrew Wachler has presented for FASA numerous times in the area of HIPAA Compliance.
If you have any questions or would like to retain our services, please call our offices at (248) 544-0888.
Corporate & Transactional Law:
WACHLER & ASSOCIATES, P.C. has specific expertise in providing a wide variety of clients with advice and counsel regarding their corporate structure and business relationships. In addition to the fraud, abuse and compliance analyses we perform with respect to our health care clients' contractual relationships, we have significant experience in the preparation, review, and negotiation of corporate transactions for both health care and non-health care industry clients, including:
- Joint ventures;
- Mergers, acquisitions, affiliations and divestitures;
- Employment, independent contractor and management relationships;
- Confidentiality and non-competition agreements;
- Shareholder and partnership agreements; and
- Equipment sales, leasing and financing.
We counsel our clients with advice and guidance through all phases of business operations from entity selection through the negotiation and preparation of operational documents for corporations, limited liability companies and partnerships
Licensure/Medical Staff Privilege Matters:
WACHLER & ASSOCIATES, P.C. has specific expertise in counseling and representing health care provider clients in sensitive licensure and medical staff privilege matters. Our firm handles such matters on behalf of physicians, dentists, podiatrists, chiropractors, nurses and other health care providers, both in-state and abroad. The consequences that State licensing actions or hospital adverse actions may have against a health care provider are numerous, including, but not limited to, criminal actions, additional actions by other states and/or hospitals, reports to state and national databanks, and third party payor departicipation. A health care provider facing a State health care investigation/administrative action or a potential adverse action by a hospital against his or her staff privileges cannot afford to take a myopic view of his or her predicament. Due to the domino effect that often accompanies the imposition of state-imposed sanctions and/or hospital disciplinary action, such providers are well advised to obtain experienced health care counsel who will take an expansive view of the matter in order to assess the collateral damage that could result from a proposed settlement. Any settlement strategy should take into consideration all of the collateral sanctions and enforcement actions that could arise as a result of a settlement. WACHLER & ASSOCIATES, P.C. understands this and has the experience necessary to resolve these matters with minimum collateral effect.
If you have any questions regarding State health care investigations/licensing matters or hospital staff privilege matters or if you would like to retain our services, please call us at (248) 544-0888.
Radiology and Diagnostic Imaging Centers:
WACHLER & ASSOCIATES, P.C. has expertise in counseling and representing radiology providers, including physician groups and diagnostic imaging centers, in all aspects of health care law. We represent radiology providers in the areas of fraud and abuse and Stark laws; billing and compliance issues; third party payor audits; corporate formation; and other health care legal matters.
Attorneys at WACHLER & ASSOCIATES, P.C. counsel clients on legal issues associated with the development, acquisition, and operation of imaging centers. Imaging centers may be furnished through facilities owned by radiologists, non-radiologists, hospitals, management companies, individuals and other joint venture arrangements. The legal issues affecting the imaging center will vary depending upon the ownership interests in the center. The modalities offered at the imaging center may also affect State CON and licensure laws.
WACHLER & ASSOCIATES, P.C. also represents radiology clients with regard to Medicare billing and reimbursement issues associated with diagnostic imaging services, such as the treating physician ordering rule, the additional diagnostic radiology test exception, supervision requirements, reassignment issues, and service specific coverage issues. Our firm has worked with numerous radiology clients developing and implementing practical but effective compliance programs. We also assist our compliance clients in maintaining the effectiveness of their programs through ongoing educational and monitoring and auditing services.
If you have any questions or would like to retain our services, please call our offices at (248) 544-0888.
