SKT has one of the premier healthcare practices in the country and can assist you in the following areas:
Business Transactions
- Formation of entities and business structure
- Physician and Medical Director contracts
- Purchase and sale agreements
- Negotiation of payor contracts
- Service agreements and vendor contracts
- Employment and independent contractor agreements
Regulatory Defense
Department of Public Health (“DPH”) licensure investigations and appeals
Reimbursement audits by private and governmental payors and their contractors CMS
- Medicare
- Medi-Cal
- National Government Services
- Fraud and abuse investigations by government payors and their contractors
- Safeguard Services
- Office of Inspector General
- Federal Bureau of Investigations
- Department of Justice
- Department of Health Care Services
- Bureau of Medi-Cal Fraud and Elder Abuse
- Audit defense
- Zone Program Integrity Contractor (“ZPIC”) (which replaced the Program
- Safeguard Contractors (PSC)
- Recovery Audit Contractor (“RAC”)
Compliance
- Licensing, operational, and reimbursement compliance
- Medicare and Medi-Cal enrollment and changes of ownership
- Corrective action plans and other compliance strategies
- Prepayment review
- Licensure citations and deficiencies
- Medicare and Medi-Cal enrollment errors
- Audit risk assessment
- Medical necessity of hospice claims
- Length of stays and number of nursing home patients
- Physician certifications and re-certifications
- Local Coverage Determination compliance and documenting medical necessity
- Terminal status in routine hospice claims
- Special physician service claims
- Inpatient hospice claims
- Compliance with hospice cap
- HIPAA and state patient data privacy and security requirements False Claims Act compliance for marketing and business development activities
Litigation
- Licensure defense and appeals
- Medicare and Medi-Cal provider enrollment appeals
- Payor and reimbursement disputes
- Overpayment appeals
- False Claims Act/qui tam whistle-blower litigation defense
- Business and employment litigation
- Medicare and Medi-Cal exclusions and suspensions by government entities CMS
- Office of the Inspector General
- California Department of Health Care Services