Health Care Governance, Regulatory Compliance and Reform Issues

The Pannone Lopes Devereaux & O'Gara LLC health care team consists of experienced litigators who are intimately familiar with how health care, employment and corporate concerns collide. Our team combines technical experience and litigation skills to represent and assist clients involved in all aspects of the health care industry.

Corporate Governance and Contracting

The PLDO business law team assists health care entities in all aspects of corporate formation, expansion, joint ventures, mergers and acquisitions. We routinely assist clients in structuring an organization or modifying its corporate governance. PLDO routinely represents both for-profit and nonprofit organizations. The firm has created alliances with consultants to develop a center for excellence for nonprofit organizations to assist them in finding and using state-of-the-art methods to operate more effectively.

PLDO also provides its clients with an understanding of corporate governance, including fiduciary responsibilities, committee membership responsibilities, and establishing policies and procedures and corporate compliance programs. Our attorneys serve as board members for numerous charitable organizations, meaning that we not only advise clients on professional and ethical standards for corporate board members, but we put those standards into practice ourselves every day.

Contracting in the health care arena can expose organizations to fraud and abuse liability based upon relationships that would be considered a best practice in most industry groups. This is a particular concern for institutions that import leadership from other industries. Crafting an incentive program to encourage referrals might lead to enhanced profits in other industries, but in the health care industry, it would likely constitute a violation of the Anti-Kickback Statute. PLDO's health care team works with our clients to maximize the value of their contractual relationships while steering clear of the many pitfalls inherent in this highly regulated industry.

Regulatory Compliance and Reimbursement

The PLDO health care team possesses the requisite experience to deal with myriad legal and business issues relating to implementing effective compliance programs or preventing an unwanted enforcement action. PLDO lawyers guide clients through the maze of regulation in an effort to avoid inadvertent mistakes that sometimes result from an organization's lack of regulatory awareness or not having designed and implemented an effective compliance program.

We will conduct risk assessments to identify corrective action and provide the guidance needed to establish compliance training programs at all levels of the organization. Effective compliance programs must be proactive if they are to serve as a mitigating factor in an enforcement action. A "paper program" will not deter violations and has little to no mitigating effect in a potential enforcement action.

The cost of developing and implementing an effective compliance program is far less than the potential treble damages and government attorneys' fees that may result from even a minor False Claims Act violation. Developing and implementing an effective compliance program will also enhance the organization's ability to maximize reimbursements. Government agencies are vigilant in preventing overpayments; however, they do not assist providers or suppliers in capturing all available reimbursement. PLDO attorneys work with the client to maintain a current understanding of the constantly changing legislation and regulations while maximizing the reimbursement opportunities that are so essential to the client's financial viability.

Health Care Reform

Among the most far-reaching aspects of health care reform is the meaningful use requirement for electronic health records. PLDO assists clients in securing incentive payments available to providers who make meaningful use of certified health record technology.

The effects of recent health care reform legislation vary significantly depending on the nature of the organization. Reimbursement, compliance, HIPAA, and fraud and abuse laws are among the numerous areas undergoing significant change, and PLDO works with clients to focus on the aspects of reform that apply to their organization.

To learn more about how PLDO can help you address your employment law issues, contact our firm. Headquartered in Providence, Rhode Island, we serve clients nationwide and have offices in Connecticut, Florida, Massachusetts and New York.