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