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Medical Fraud & Abuse

Giordano Halleran & Ciesla’s Health Care Fraud Practice group offers a full range of services relating to legal issues that confront health care providers in maintaining corporate compliance and in responding to governmental and payor investigations and inquiries. GH&C has represented hospitals, pharmaceutical companies, nursing homes, home health care providers, durable medical equipment suppliers, physicians, laboratories, rehabilitation facilities, and medical transportation providers (including BLS/ALS) in a number of State and Federal matters involving fraud and abuse issues.

The members of the Health Care Fraud Practice group utilize their backgrounds in health care and as former government prosecution and HHS attorneys, coupled with their experience in regulatory compliance and investigations to provide their clients with sound legal advice and practical solutions. GH&C's collective knowledge and experience enables our attorneys to handle civil and criminal health care fraud matters on the federal and state level, as well as provide representation concerning overpayment claims and alleged violations of both the Medicare Conditions of Participation and EMTALA.

GH&C provides counseling and analysis of legal issues designed to help health care providers maintain compliance with health care fraud and abuse laws, including the federal anti-kickback law, the federal Stark statute, the federal and New Jersey False Claims Acts, the New Jersey Codey law, and related legal and regulatory authorities. GH&C has worked with numerous clients in conducting compliance related internal audits, reviewing proposed and existing business relationships for compliance with applicable laws, and conducted due diligence reviews for legal compliance. In addition to assisting clients in responding to overpayment claims, GH&C has represented clients who have been the focus of both state and federal grand jury investigations in the health care arena, as well as civil investigations conducted by the U.S. Department of Justice, the HHS Office of Inspector General and state authorities. GH&C has worked with clients to develop codes of conduct, compliance plans and compliance training for health care providers.

GH&C has represented healthcare providers and their employees (where separate counsel is appropriate) in connection with the following:

  • Investigations of violations of the Medicare billing regulations by the Department of Justice and the HHS OIG.
  • Defense of overpayment claims asserted by Medicare, Medicaid and other third party payors.
  • Negotiation of civil monetary penalty settlements with the HHS Office of Inspector General and various state agencies.
  • Obtaining a favorable advisory opinion from the HHS Office of Inspector General.
  • Review and analysis of issues arising from potential Medicare exclusion of individual health care providers.
  • Defense of Qui Tam actions

GH&C's attorneys are involved in the New Jersey State Bar Association Health and Hospital Law and Criminal Sections, Healthcare Financial Management Association, the National Association of Criminal Defense Lawyers, the American Health Lawyers Association, and various other health care associations, and have been recognized by Best Lawyers in America, Chambers USA, Super Lawyers and the firm is “AV rated” by Martindale-Hubbell.

Giordano, Halleran & Ciesla, P.C. | Red Bank, NJ | Trenton, NJ | Newark, NJ | New York, NY | www.ghclaw.com | 1-800-842-1LAW