Health care providers are facing an unparalleled number of audits and investigations from federal, state and private payors attempting to prevent fraud and abuse and reduce health care costs. Such audits and investigations can lead to serious monetary penalties for providers, and in some instances even lead to criminal charges.
ROLF regularly counsels and defends providers subject to governmental investigations related to Medicare fraud, Medicaid fraud, kickbacks, and False Claims Act violations, including qui tam actions, allegations of upcoding, and/or allegations of billing for services not rendered or not medically necessary. ROLF regularly defends audits by federal contractors as well, such as those by Zone Program Integrity Contractors (ZPICs) and Recovery Auditors (fka RACs).
ROLF also offers counseling on those preemptive actions that reduce the likelihood of audits and investigations from occurring. Services can include the development of billing compliance policies and procedures, assisting clients in the structuring of arrangements to comply with both federal and state fraud and abuse laws, and the issuance of compliance opinions.
ROLF’s seasoned team handles a wide range of false claims and whistleblower defense. Our outstanding track record includes:
- Won the dismissal of a multi-million dollar Qui Tam Complaint filed under the False Claims Act asserting improper kickbacks between a nursing facility chain and ancillary service vendors.
- Obtained a dismissal with prejudice for a 8 facility nursing facility chain named in a Qui Tam Complaint under the False Claims Act asserting the therapy provider was providing unnecessary services by “hugging the rug”
- Defended and negotiated a positive result for a 80 facility nursing facility chain named in a Qui Tam Complaint under the False Claims Act asserting upcoding by a therapy vendor.
- Obtained summary judgment and then won in the District Court of Appeals in a series Medicaid Fraud cases brought by the Ohio Attorney General against over 90 nursing homes for laboratory service billings.
- Represented many long term care providers in responding to investigations and subsequent litigations by the OIG and State Medicaid Fraud Control Units.