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Litigators For The Health Care Industry

Lashly & Baer, P.C., has represented health care providers for more than 40 years. We are counsel to major health care systems in St. Louis, several independent hospitals, long-term care facilities, the area’s largest air and ground ambulance services, and nursing homes. Plus, we represent more than 50 hospitals and nursing homes across the states of Missouri and Illinois. These clients come to us through both insurance carriers and self-insurance programs. Issues involve professional and general liability matters such as design and use of medical equipment, denial of medical staff privileges, and intentional tort actions such as false imprisonment and assault.

We regularly litigate reimbursement matters on behalf of providers and against Medicare, Medicaid and managed care entities. One such action netted an additional $5.9 million for our client.

We also assist health care professionals who need assistance for matters regarding professional liability.

We regularly handle the following legal issues for our clients:

  • Administrative hearings and appeals of regulatory actions by state and federal agencies
  • Certificate of Need appeals
  • Facility/professional licensing
  • Fraud and abuse/anti-kickback litigation
  • General liability matters involving visitors and patients
  • HIPAA claims
  • Medical staff issues
  • Medicare, Medicaid and managed care reimbursement
  • Product liability actions pertaining to the performance, design and use of medical equipment
  • Professional liability/malpractice claims
  • Restrictive covenants/unfair competition
  • Vendor breach of contract actions

Your License Is Your Livelihood.

Our attorneys have the requisite knowledge and experience to understand the nuances of the health care system needed to defend state licensure actions. Most matters start with what appears to be a simple complaint or request for a statement that on its face seems innocuous, but in reality sets the tone for the entire investigation. Our attorneys are experienced in all phases of licensure actions from the initial complaint, to meeting with investigators, to preparing licensees to testify before respective boards, and if needed, litigation before the Administrative Hearing Commission and through the appellate process.

The biggest mistake health care providers make is attempting to handle these types of matters themselves. The best strategy is to involve legal counsel at the earliest opportunity to understand the issues you could potentially be facing and drafting the proper response and creating the narrative from the outset. State licensure efforts have been on the increase in the last several years. We have seen licensure boards become more active and aggressive in pursuing potential disciplinary actions.

Many health care professionals do not realize until it is too late that state licensure boards and registration agencies share information, especially involving the opiod epidemic. You need to be considering interactions with multiple agencies at the investigation stage. We are here to assist in protecting your livelihood.

Healthcare Compliance Plans

Lashly & Baer regularly collaborates with healthcare providers to develop, implement and maintain Compliance Plans which are designed to comply with the Office of Inspector General’s Compliance Guidance publications. Often, when healthcare providers hear the term “Compliance Plan, they think that all they are going to receive is a lengthy document telling them “Don’t do this”. Our goal is to go far beyond providing this type of list.

We understand that the myriad of Federal and state healthcare regulations become so complicated and cumbersome, that healthcare providers feel that they have a disincentive to pursue new patient care services and product innovations. In collaborating with healthcare providers, we not only want to provide a road map for compliance with those regulations, we try to provide a road map to assist those providers in adding new lines of service or to consider ventures with other healthcare providers.

We know that in the area of Compliance Plans, “one size does not fit all”. We tailor these Compliance Plan efforts to the size and scope of the provider. We’ve also found that by collaborating with providers and other professionals such as accountants, coders, and billing companies, our compliance training activities often assist employees identify areas in which the providers are failing to capture the revenue to which they are entitled for their services.

Government Investigations

We have represented clients in federal and state government investigations and litigation matters initiated by the Criminal and Civil Divisions at the Department of Justice, United States Attorneys, the Office of Inspector General for the Department of Health and Human Services (“OIG”), the Drug Enforcement Administration (“DEA”), the Food and Drug Administration (“FDA”), State Drug Enforcement Bureaus and Agencies, State Attorneys General, Medicare and Medicaid contractors, and Medicaid Fraud Control Units. We have helped clients avoid potentially devastating civil fines, administrative penalties, and exclusion by combining our team’s knowledge with our investigative, regulatory, and litigation capabilities.

We routinely assist a wide spectrum of healthcare clients in navigating, resolving and, when needed, litigating highly sensitive government enforcement matters on behalf of health systems, hospitals, physician practice groups, nursing homes, home healthcare providers, laboratories, third party vendors, and durable medical equipment suppliers, among others. Our team handles investigations that often start with a “knock on the door” from a state or federal agency investigator seeking information and client records pertaining to ever increasingly regulated areas such as Medicare/Medicaid billings, controlled substance prescriptions, FDA compliance, medical device and drug safety issues including investigations and enforcement actions related to the opioid crisis, and illicit referral arrangements among healthcare providers. We assist clients in responding to these investigations with proactive strategies aimed at completely avoiding – or at the very least minimizing – fines, penalties, exclusion, and negative publicity while preventing disruption to business operations as much as possible. We consistently strive to obtain optimal results for our clients by leveraging our strong relationships with government agencies along with our reputation of integrity and efficiency. Our strategies have produced outstanding results for our clients in avoiding criminal charges from being filed and in mitigating damages sought by the government.

Our team handles all aspects of government investigations, from requests for documents, subpoenas or civil investigative demands, to witness interviews and depositions, negotiation with agency personnel and U.S. Attorneys, the structuring of settlements and, as appropriate, corporate integrity agreements or certification of compliance agreements. We also regularly work with clients to facilitate and manage large-scale document production and retention aspects of these investigations. Lashly & Baer attorneys:

  • Have a significant experience working with the U.S. Department of Justice, U.S. Attorney’s Offices, the Department of Health and Human Services, OIG, FDA, DEA, State Attorneys General, State Drug Enforcement Bureaus and Agencies, and various State Medicaid Fraud Control Units.
  • Investigate and litigate cases involving the False Claims Act, Anti-Kickback Statute, and Stark Law.
  • Possess a comprehensive understanding and expertise in Medicare and Medicaid reimbursement investigations, audits and appeals involving Recovery Audit Contractors (“RACs”), Medicare Administrative Contractors (“MACs”) and various State Medicaid contractors.

To discuss these matters with our attorneys, contact us at 314-621-2939 or use the contact form.

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