Healthcare Representations and Warranties in the M&A Transaction

Healthcare industry mergers and acquisitions can take on many shapes and sizes dictated by various regulatory and business law issues, but common to all such transactions is the Target’s obligation to make healthcare representations and warranties to the Acquiror.    Representations and warranties (R&Ws) in general are heavily negotiated aspects of the parties’ agreement, and their …

Regulatory Considerations for the Structure of Practice Entities

Healthcare providers have additional regulatory restrictions related to the structure of their practice entities (“Practice Entities”), which are not applicable to those operating in other industries.  Such restrictions include but are not limited to ownership and control by licensed professionals and limitations on the number of Practice Entities that a licensed professional may own or …

Accurately and Thoroughly Conduct a HIPAA Security Risk Analysis – Or Risk a $100,000 Fine (or More)

On the surface, it seems like an obvious choice – follow the law and avoid the risk of a hefty fine – but health care providers may learn the hard way that implementing HIPAA Security Rule requirements is, in fact, more complicated than it might first seem. According to a recent U.S. Department of Health …

Launch of the Criminal Division’s In-House Health Care Data Analytics Team

In its “2017 Year in Review” (https://www.justice.gov/criminal- fraud/file/1026996/download), the Fraud Section in the Criminal Division of the US Department of Justice announced the launch of its Health Care Fraud Unit’s Data Analytics Team. While the use of data analytics is not new to the Department of Health and Human Services and civil enforcement section of …

The Trump Administration Proposes a Budget Increase to Fight Healthcare Fraud

The Trump administration proposed a budget increase of 19 million to aid in the fight against health care fraud. This showcases the continued (and heightened) importance of anti-fraud programs, especially compared to the suggested $18 billion in cuts to other health-care related programs. If approved by Congress, the budget increase will result in an increase …

Obligations and Expectations Surrounding Healthcare Compliance Programs

The phrase “healthcare compliance program” is commonly used to describe those processes and procedures implemented by a healthcare provider to prevent submission of erroneous claims and combat fraudulent conduct. The expectation is that providers using internal controls will more efficiently monitor adherence to legal and regulatory requirements than providers without such controls in place1. However, …

Frequently Asked Questions on the Certificate of Need Process for Surgical Services

Michigan is among many states that require entities to obtain a Certificate of Need (“CON”) before performing most surgical services. While a CON is just one out of several legal and regulatory requirements that must be addressed in these situations, the process of applying for and winning approval of a CON from the Michigan Department …