Experienced Nationally Recognized Healthcare Lawyers

We regularly represent a wide variety of healthcare providers and suppliers including, but not limited to: physicians, hospitals, home health agencies (HHAs), skilled nursing facilities (SNF), hospices, ambulatory surgery centers (ASCs), physician organizations (POs), physician hospital organizations (PHOs), laboratories, pharmacies, accountable care organizations (ACOs), urgent care centers, independent diagnostic testing facilities (IDTFs), durable medical equipment (DME) prosthetics, orthotics and supplies (DMEPOS) and other medical device and equipment suppliers, substance abuse and addiction medicine providers, and many others.

Our attorneys tailor services to address clients’ specific needs. Whether you are facing significant legal challenges, proactively structuring your healthcare business to comply with rules and regulations, or simply need a “go to” firm for day-to-day legal guidance, our Michigan healthcare lawyers provide efficient and effective legal representation. Our widespread experience and innovative thinking often result in strategies and approaches that others have not considered.

The lawyers of Wachler & Associates, P.C. specialize in all areas of healthcare law. We guide our clients through the legal aspects of health care so that they can focus on their business and patient care. Our attorneys regularly work with providers’ existing counsel to provide the healthcare expertise required to advise healthcare clients. We have extensive experience representing providers in all areas of healthcare law, including, but not limited to:

Stark Law, Anti-Kickback Statute, Fraud & Abuse

Our attorneys structure healthcare entities and transactions to comply with the federal Stark law, federal Anti-Kickback Statute, and other federal and state health care authorities governing healthcare fraud and abuse and relationships between healthcare providers and other entities.

The Stark law, often referred to as the federal physician self-referral prohibition, governs the ability of physicians to refer certain types of Medicare and Medicaid services to entities with which the physician (or an immediate family member of the physician) has a financial relationship. Our firm has advised clients regarding the Stark law since its inception in 1995, and we regularly assist providers in analyzing whether Stark applies to a given situation and, if so, whether a Stark law exception is available for the arrangement and how to structure the arrangement to comply.

Our attorneys also have vast experience advising providers and evaluating relationships under the federal Anti-Kickback Statute (AKS), which generally prohibits healthcare providers from providing or receiving any kind of remuneration in return for the referral of Medicare, Medicaid or other federal healthcare program services. The AKS is a criminal statute and interpreted broadly, and a violation of the AKS has significant implications on health care entities.

Similarly, our Michigan healthcare lawyers represent providers regarding state laws governing self-referrals, kickbacks, fee splitting, the corporate practice of medicine, and other laws. These laws often extend federal prohibitions to all payors and thus all patients, and must be analyzed.

In addition to the federal and state fraud and abuse laws discussed above, health care providers and other entities may be further restricted by federal or state billing rules (for example, Medicare and state anti-markup rules), requirements of private payors, Medicare and other payor conditions of participation or certification, certificates of need and notice requirements, among other applicable authorities.

The attorneys at Wachler & Associates have over 35 years of experience structuring business operations, arrangements, contracts, policies and procedures to comply with federal and state fraud and abuse laws. Our team is prepared to guide your entity or transaction through these complex authorities.

Recovery Audit Contractor (RAC), Medicare, Medicaid, & Third Party Payor Audits

Wachler & Associates is a nationwide leader in defense and appeals of healthcare audits and overpayment demands. Since 1980, we have defended thousands of audits nationwide on behalf of our clients. We defend audits on behalf of all provider types, including, but not limited to, physicians, hospitals, home health agencies (HHAs), SNFs, hospices, laboratories, DMEOPOS, IDTFs, inpatient rehabilitation facilities, LTCHs, pharmacies, and many others. Our attorneys regularly give presentations on audit topics to national legal and healthcare organizations.

In order to combat the increasingly high cost of health care, federal and state governments and private payors are increasingly focused on targeting fraud, abuse and waste in the health care industry. This focus has resulted in an unprecedented spike in the number of Medicare, Medicaid and third party payor audits. Recovery auditors have significant authority and cast a large net, and no provider is immune from a healthcare audit. Our lawyers are experienced in defending Medicare, Medicaid, and private payor audits and will help you navigate the often frustrating appeals process.

Our audit defense team offers a wide variety of services. We can be involved in every step of the process, including handling all submissions and levels of appeal. We can also assist you by drafting templates, identifying and coordinating experts, overseeing your internal audit team, or appearing at hearings on your behalf. Our lawyers are also available to represent clients during day-to-day communications with audit contractors. We have witnessed firsthand the burdens associated with communicating with recovery audit contractors and remedying the errors contractors often make throughout the audit and appeals process.

Our attorneys are also on the forefront of changes in the Medicare appeals process, including representing providers in Medicare’s Settlement Conference Facilitation (SCF) program. SCF is an efficient, expedient way to resolve high volumes of Medicare claims appeals stuck in the Medicare appeals backlog.

Healthcare providers that face audit demands require specialized healthcare audit attorneys. Our more than 35 years of experience defending audits and overpayment demands makes us the right choice for providers and suppliers of all types and sizes.

Health Care Business Transactions

When structuring health care business transactions, entities must account for the rules, regulations, and other considerations specific to the healthcare industry. Our attorneys regularly assist health care providers and other entities in structuring business transactions to both meet their business goals and remain compliant with state and federal rules and regulations, including the Stark law, AKS and state self-referral, anti-kickback, fee-splitting, corporate practice of medicine and other relevant laws. Whether you are purchasing, selling, restructuring or forming a new entity or joint venture, our experienced health law attorneys can lead you through the process – from planning the structure and analyzing the regulatory implications, to drafting the required corporate and transactional documents.

Healthcare Regulatory & Compliance Law

In today’s regulatory environment, healthcare providers and other entities must remain compliant with the always changing rules and regulations facing the healthcare industry. While almost all of our practice areas involve regulatory compliance, a review of your entity’s compliance with applicable authorities or the implementation of an effective compliance program will mitigate risk for your health care entity. Compliance plans create a culture of compliance within your entity, provide security and demonstrate good faith in the event of a government or other third party investigation. Our healthcare regulatory and compliance attorneys have been structuring compliance plans for over 35 years, from assessing risk, to policy development, to implementation and maintenance of an effective compliance program. In addition to being a wise business decision in the current audit and regulatory landscape, compliance programs are increasingly required by state and federal laws for certain provider types, for example skilled nursing facilities. Our firm can help your health care business remain compliant and develop an effective compliance program that will meet the requirements of applicable laws and help your entity avoid audits and overpayment demands.

HIPAA, HITECH & Privacy Laws

While health care providers generally understand the need to maintain the confidentiality of patient information, it is often difficult to understand and comply with the nuances and complexities of HIPAA’s Privacy, Security and Breach Notification rules, federal regulations protecting the confidentiality of information related to substance abuse treatment (42 CFR Part 2) and state confidentiality laws. The attorneys at Wachler & Associates have advised clients on HIPAA compliance and related patient privacy issues since the publication of the original HIPAA Privacy Rule in 2000. Our HIPAA compliance attorneys have also counseled clients on the necessary changes required by the amendments to the HIPAA Privacy and Security Rules that resulted from the HITECH Act and the Final Omnibus Rule, as well as the Breach Notification Rule. Whether you are a business associate or a covered entity, we can assist with the development of HIPAA Privacy, Security and Breach Notification policies and procedures, as well as conducting and documenting the risk assessment and risk management processes. Our attorneys are also available to consult on HIPAA compliance issues as they arise, such as assisting in determining whether a requested disclosure is permissible or assessing whether a breach notification is required.

Additionally, because HIPAA has been expanded to apply directly to business associates, our firm often represents vendors and other entities that provide support for the health care industry in understanding their HIPAA obligations and assist, for example, with the drafting of business associate agreements, as well as business associate subcontractor or “downstream business associate” agreements.

Our firm is also experienced in representing entities subject to complaints, investigations, or compliance reviews pursued by the Department of Health and Human Services’ Office of Civil Rights (OCR) or other state or federal agencies.  We are also well-equipped to represent entities who have been selected either for a desk or onsite audit for the recently announced 2016 Phase 2 HIPAA Audit Program.

Other Practice Areas

In addition to the above practice areas, Wachler & Associates has significant experience with matters including:

• Licensing, Staff Privileges, and Credentialing
• Supply Chain and Purchasing
• General Healthcare Counsel
• Provider and Supplier Enrollment and Participation Matters
• Healthcare Litigation
• Certificates of Need
• Employment Issues
• Healthcare Billing and Reimbursement
• Healthcare Fraud
• Managed Care
• and substantially all other areas of health care law.

Please visit our practice area pages to learn more about each practice area.

We encourage you to explore our website to learn how Wachler & Associates can help you and your healthcare entity meet your unique health law challenges.