Fraud & Abuse

Because federal and state fraud and abuse laws affect virtually every health care provider transaction and all aspects of provider operations, PPSV serves health care providers on two fronts: 

• Our experience enables us to interpret complex provisions to offer meaningful, practical solutions to compliance issues, to guide client transactions and develop corporate compliance programs such that investigations and sanctions under fraud and abuse laws are avoided. 
• Our careful monitoring and analysis of regulatory agency actions allows us to distill this intelligence and proactively report to clients on the potential impact of pending legislative and regulatory action on operations and compliance efforts. 

PPSV counsels clients on compliance with all federal and state fraud and abuse laws, including:

• Anti-kickback statute
• False Claims Act
• Civil Monetary Penalties law
• Stark self-referral law
• Similar state provisions

Fraud Investigation and Prosecution

Prosecutors and regulatory agencies nationwide have dramatically increased their investigative and prosecutory efforts targeting health care providers, utilizing recently-expanded criminal, civil and administrative enforcement powers as a key strategy in the process. PPSV attorneys are well equipped to handle all types of investigations and enforcement proceedings and have attained considerable success on behalf of clients. We have resolved investigations through obtaining criminal declinations or negotiating favorable settlements with the government.

PPSV represents and defends clients in every phase of the investigative process, including:

• Administrative and Office of Inspector General investigations and proceedings
• Grand Jury proceedings
• Independent counsel and Congressional investigations
• Civil and criminal litigation

Our attorneys have extensive experience and powerful resources to pursue the most favorable outcome for our clients. We apply persuasive strategies at the negotiating table during interaction with prosecutorial agencies; in litigation, our aggressive advocacy results from our significant experience representing clients in hundreds of court actions before all administrative agencies and tribunals in the federal, state and local courts.

Corporate Compliance

PPSV has extensive experience assisting a wide range of health care providers in developing and implementing corporate compliance programs.  Our experience includes:

• Assistance with identification of reimbursement and related areas to be addressed in the compliance plan
• Providing legal advice on requisite features of a compliance plan
• Furnishing practical advice on how to implement the plan within provider operations
• Addressing perceived or actual problems detected through compliance initiatives, including voluntary self-disclosure
• Protection from qui tam suits

PPSV also counsels clients regarding the EMTALA anti-dumping provisions, including the development of policies and protocols to comply with EMTALA rules and, if necessary, providing representation if an investigation of noncompliance is undertaken by federal authorities.