Fraud & Abuse

DCBA provides counsel on compliance with federal and state health care fraud and abuse statutes, including the federal False Claims Act, criminal Health Care Fraud Statute, Stark Law, and Anti-Kickback Statute; and state anti-kickback, patient brokering, and fee-splitting statutes.

Federal and state lawmakers are increasingly introducing and passing new fraud and abuse statutes that either can be very broad or target certain health care sectors. As a result, compliance programs can quickly become out of date, exposing organizations and providers to risk.

Whether clients need rapid response, a thorough business analysis and risk assessment, or development of a comprehensive compliance program, we help them stay on the cutting edge.

  • Anti-Kickback Statute safe harbor analysis and compliance
    • Equipment and space leases
    • Personal services and management contracts
    • Referrals
    • Discounts
  • Best practices development
  • Business operation reviews and recommendations
  • Compensation agreements
    • Between addiction treatment programs and recovery residences (sober homes)
    • Between clinical laboratories and health care organizations and ordering providers
    • Between clinical study sponsors and study participants and providers
    • Between marketing entities and health care organizations
    • Fair market value analyses
    • Pass-through billing
  • Compliance program development
  • Corporate structure and affiliations
  • Corrective action plans
  • Due diligence reviews
  • Internal investigations
  • Leases between health care organizations and other providers
  • Marketing services agreements
  • Medical necessity analysis and documentation
    • Clinical laboratory services
      • Coding and claims submission
      • Frequency of testing
      • Laboratory requisition forms
      • Testing methodology
        • Definitive, quantitative, or confirmatory tests
        • Presumptive or qualitative tests
      • Test selections (analytes and metabolites for drug detection)
      • Timely review and use of results
      • Ordering provider attestation statements
    • Controlled medication storage, prescribing, dispensing, administration, disposal, and returns
  • Provider and staff training
  • Risk analyses
  • Service agreements
    • Clinical laboratory services
    • Marketing services
    • Phlebotomy and specimen collection services