Healthcare Compliance, Regulatory Matters, HIPAA, Peer Review, and Managed Care
In a heavily regulated healthcare industry, the attorneys at London Amburn bring experience and understanding of the complex and constantly changing statutory and regulatory framework in which healthcare providers do business. Our attorneys work with various health care providers to review and structure business arrangements, taking into consideration the Stark self-referral law, the Anti-Kickback Statute and the False Claims Act, as well as Tennessee healthcare laws. We also regularly advise physicians, physician groups, allied health professionals, diagnostic facilities, and other ancillary healthcare providers about issues arising under the federal and state reimbursement laws and regulations and work with clients to develop strategies to deal with voluntary reporting and repayments to third party payers.
Our clients seek guidance in developing and implementing compliance programs to monitor ongoing regulatory compliance in their business operations and to ensure the protection of private health information. London Amburn, attorneys work with healthcare clients – and those who do business with them – to develop the policies and procedures required to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its evolving privacy and security standards.
London Amburn also offers legal advice about Group Peer Review cases. Our attorneys have experience with situations where physicians are subject to group peer review and have assisted the physicians with their provider dispute resolution process, including appeal of unfavorable decisions regarding network participation privileges. The attorneys at London Amburn make every effort to fully advise clients on the importance of protection of the confidentiality of peer review activities throughout the process.
While the concept of Managed Care was intended to reduce the cost of providing health benefits and improve the quality of care, health care clients may nevertheless face denial of reimbursement in a variety of situations. The attorneys of London Amburn have achieved favorable results for clients in dealing with managed care organizations in resolving contested matters.