Practice Areas
Our practice includes representation in:
Fraud and Abuse Compliance:
- Clients facing allegations of fraud and abuse
- Defense of civil and criminal healthcare fraud
- Medicare, Medicaid, and Insurance Fraud Defense
- Anti-Kickback and Stark Laws
- Qui Tam / Whistleblower representation
- Corporate Integrity Agreements
- Defense / Internal Investigations
- DEA Representation
- Self-Disclosure
- AHCA Investigations, Payment suspensions, Terminations
- Civil Monetary and Exclusion Actions
- Civil Monetary and Exclusion Actions
- Asset seizures and protections
- Drafting Compliance Plans, Policies and Procedures
- Compliance Program Assessment
- Compliance counseling
We represent clients before the following agencies:
- U.S. Department of Justice
- Federal Bureau of Investigation
- Drug Enforcement Administration
- U.S. Attorney´s Office
- Office of the Inspector General
- Agency for Health care Administration
- Centers for Medicare & Medicaid Services
- Medicaid Fraud Control Unit
- Florida Attorney General
- Professional Licensing Boards
- Florida Department of Health
- Florida Department of Financial Services Insurance Fraud Division
- Food and Drug Administration
- Internal Revenue Service
Professional and Healthcare facility Licensure and Certification Matters:
- Professional licensing board representation
- Department of Health Investigations
- Medical facility licensure and permits
- Administrative complaints and investigations: physicians, dentist, nursing, chiropractic, clinical social worker, psychologists, pharmacists and therapists
- Licensure representation for medical facilities, including pharmacies, CMHC. clinics, home health agencies, substance abuse treatment centers, laboratories, DME and other providers and suppliers.
Regulatory Matters:
- Cost report representation
- Healthcare Billing and Coding Management
- Reimbursement issues
- HIPAA-related issues
- Private insurance contract terminations
- Contracting and credentialing, review and negotiation of healthcare insurance
- Due diligence and risk exposure analysis for acquisitions and mergers
- Overpayments, audits, payment suspensions, termination and overpayment appeals
Strategic Legal Solutions for Healthcare Providers
Legal Services for Healthcare Providers
Healthcare fraud
Healthcare fraud involves the illegal filing of false healthcare claims to gain profit. Common schemes include billing for services not provided, unnecessary treatments, falsifying claims or records, misrepresenting services, and overcharging for care.
Enforcement Agencies
Enforcement of healthcare fraud is handled by agencies such as the U.S. Department of Justice (DOJ), Office of Inspector General (OIG), FBI, and the Centers for Medicare & Medicaid Services, among others. Several civil and criminal laws are used to prosecute healthcare fraud cases, making it a serious legal offense.
Protecting Your Professional License
Healthcare professionals face increased scrutiny, and any investigation into your professional license can threaten your career and reputation. Vitale, Suarez & Associates, P.A. specializes in providing legal representation to protect your rights during such investigations. With a proven track record of successfully defending a wide range of healthcare professionals, including physicians, nurses, and therapists, the firm often resolves cases through settlements or other means that allow clients to continue practicing.
Experienced Legal Defense and Risk Mitigation
The firm’s attorneys are skilled in representing licensees in administrative hearings to challenge penalties like suspensions or revocations. We also offer proactive risk analysis, helping to reduce the likelihood of sanctions and ensure the ability to practice. In addition to defense, the firm assists with license applications, renewals, and emergency suspension orders. Issues such as malpractice, fraud, or criminal convictions can compromise your license, making it essential to seek experienced legal counsel early in the process.
Immediate Action Required for Medicare or Medicaid Overpayment Notices
Receiving an overpayment notice from Medicare or Medicaid is serious and requires immediate attention. Even if you believe you’ve done nothing wrong, ignoring the notice could lead to civil, criminal, or administrative actions against you and your company. Many attempt to handle the issue themselves, but this often results in more complications, including potential fraud investigations or legal actions under the False Claims Act.
Legal Representation for Overpayment Appeals
Vitale, Suarez & Associates, P.A. has extensive experience in handling overpayment cases, audits, and appeals. We represent clients throughout the entire overpayment appeals process, aiming for the best possible outcome. Overpayment notices are typically issued after audits conducted by agencies like Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), or Medicaid Integrity Contractors (MICs), making legal counsel crucial to avoid further complications.
Immediate Action in Healthcare Fraud Investigations
Being the target of a healthcare fraud investigation can severely impact your reputation and business. The best way to avoid charges and unwanted publicity is to act quickly. The moment you become aware of an investigation, it is crucial to contact a healthcare attorney who specializes in criminal healthcare fraud. Vitale, Suarez & Associates, P.A. has over 50 years of collective experience representing clients under investigation. Led by experienced advocacy, the firm knows how to handle government investigations and works to minimize potential damage to you and your business.
Comprehensive Defense Strategy for Healthcare Fraud
The firm represents clients in investigations by federal and state agencies such as the FBI, DEA, and Medicaid Fraud Control Unit. Their approach includes conducting factual and legal investigations to gather evidence and identify relevant laws. The firm specializes in developing strong defense strategies, which may include corrective action plans. Additionally, we prepare a defense case presentation to enforcement authorities, aiming to mitigate any criminal, civil, or administrative liability and protect their clients’ interests.
Whistleblowers in Healthcare Fraud Cases
Whistleblowers are individuals, often employees or patients, who report unlawful activities within healthcare organizations. These cases are typically filed under the False Claims Act (FCA) and allow whistleblowers to bring lawsuits, known as qui tam actions, against providers engaged in healthcare fraud. The government can choose to intervene, reserve the right to intervene later, or allow the whistleblower to proceed independently. If successful, whistleblowers, or “relators,” may receive a share of the settlement or litigation proceeds.
Legal Protection and Representation for Whistleblowers and Defendants
Whistleblowers are legally protected from retaliation, and those who experience negative consequences, such as job loss, can sue for damages under the False Claims Act. Successful claims can result in double back pay and compensation for other damages, along with a share in any recovery. Whistleblower cases often involve complex fraud activities, such as unnecessary medical care, fraudulent billing, or kickbacks. Vitale, Suarez & Associates, P.A. is experienced in representing whistleblowers and defending organizations targeted by such actions.
DEA Scrutiny on Narcotics Prescribing and the Risks for Physicians
The DEA closely monitors the prescribing, distribution, and dispensing of narcotics, particularly opioids. Many healthcare professionals, even those with good intentions, may face DEA investigations due to routine inspections or complaints. Violations of the Controlled Substances Act can lead to severe consequences, including administrative actions against DEA registrations and potential criminal charges. Vitale, Suarez & Associates, P.A. provides legal defense for clients involved in DEA audits, investigations, and registration revocation hearings, ensuring the best possible outcome.
Navigating DEA Audits and Inspections
DEA inspections begin when a Form 82 or an administrative inspection warrant is presented. Registrants must provide informed consent for the inspection, which can later be used in a criminal prosecution. Consent can be refused or withdrawn, forcing investigators to obtain a search warrant. It is crucial to consult an attorney before agreeing to inspections or surrendering a DEA registration, as the consequences can be serious. Vitale, Suarez & Associates, P.A. offers experienced legal guidance to healthcare professionals facing these complex and high-stakes situations.
The Importance of an Effective Compliance Program
A compliance program is like preventive medicine for your healthcare practice, helping you identify and correct problems before they escalate into investigations. Vitale, Suarez & Associates, P.A. can assist in developing a robust compliance program, which may mitigate or even eliminate sanctions, penalties, and program exclusions if your practice becomes the target of an investigation. Effective compliance programs often lead to more favorable treatment from government prosecutors.
Building a Strong Compliance Program with Expert Guidance
The U.S. Department of Health and Human Services Office of Inspector General offers seven key guidelines for creating a compliance program, including internal monitoring, designating a compliance officer, and enforcing disciplinary standards. Vitale, Suarez & Associates, P.A. will help identify areas of concern, implement policies, and conduct regular audits to ensure compliance with evolving healthcare laws. Their experienced team ensures your practice stays up-to-date in a constantly changing regulatory environment.