Participation & Reimbursement
We have successfully enrolled, credentialed or otherwise secured participation approvals in all types of government-funded programs. We work with state and federal agencies, as well as downstream contractors and vendors, to ensure our clients are eligible and paid for services. We regularly work with providers making changes to their existing participation, responding to requests information or audits for recovery, and encountering payment issues. We have successfully challenged improper denials and termination of participation. We also have significant experience responding to nonpayment, underpayment, claims of overpayment or other recovery efforts from these programs.
California Managed Care
We have decades of experience with the evolution of managed care in California and nationally. We have a unique understanding of laws, regulations, and other agency authority that impact managed health care in policy and practice. We have experience resolving issues with the agencies and managed care plans that dominate the marketplace. We represent risk-bearing organizations, their administrators, and network providers. We negotiate and structure agreements for reimbursement, risk sharing, co-management, and incentives.
Provider & Supplier Operations
We handle operational issues for clients including medical groups, clinical and research laboratories, pharmacies, dentists, surgery centers, DME providers, long-term care providers, federally qualified health centers (FQHCs), hospices, diagnostic centers, and behavioral health providers. We have experience with required documentation for certification, survey, change of information, change of ownership, audits and investigations, accreditation, HIPAA, medical records, scope of practice, corrective action plans, compliance plans, and policies and procedures. We have successively defended clients in administrative actions involving these issues.
False Claims Act, Voluntary Self Disclosure,
and Corporate Integrity Agreements
We have assisted clients with the spectrum of issues presented by state and federal False Claims Act (FCA) violations. We have lead clients through successful discovery and voluntary self-disclosure processes. We have significant experience responding to subpoenas, Civil Investigative Demands, OIG investigations, and similar requests for information stemming from FCA allegations. We have experience with implementation and monitoring required under a Corporate Integrity Agreement (CIA) when an FCA case is resolved.
Health Technology, Telehealth & Blockchain
We have experience negotiating, drafting and reviewing agreements addressing the rights and responsibilities associated with data, usage, security, software, electronic medical records, public information exchanges, research and clinical trials, and insurance coverage for breach or disclosure. We work with providers who purchase and supply telehealth services for medical, dental, and behavioral health. We also work with mobile providers who harness advances in technology to develop and deliver services beyond traditional settings. We have experience with smart contracts to facilitate transactions. We also have assisted clients using blockchain technology to develop and deploy permissive, distributed ledgers for risk-bearing organizations, who need to verify integrity measures, compliance measures, grievance procedures, and network availability.