Today, more than ever, healthcare touches every person and organization in this country in a vital way. From licensure of professionals to certificates of need for services and facilities, from financing growth to developing new business solutions for healthcare delivery, the attorneys at Gilchrist Donnell are the advisors that facilities, providers and payors turn to for trusted guidance.
Caring for those needing long-term care and interacting with providers to ensure their needs are met present unique challenges that must be addressed by attorneys with experience and sound judgment. We have represented long-term care providers for nearly two decades. This special segment of the healthcare industry continues to rely upon our proven expertise.
The pharmaceutical industry, in all its aspects, constitutes one of the most dynamic areas of healthcare. The attorneys at Gilchrist Donnell have been closely aligned with pharmacies for more than twenty years. In addition to the more traditional retail pharmacy segment, we have also walked in recent years with various clients through the development and rapid growth of compounding pharmacies. We have the experience and expertise that pharmacies and compounders need to guide them in today's fast-paced and highly regulated market.
At Gilchrist Donnell, we are recognized leaders in certificate of need law. Fostering relationships and providing principled service have earned our attorneys the respect of healthcare providers, other counsel, and both State and Federal agencies. Over the last twenty years, we have successfully ushered applications through the CON process for new ambulatory surgical facilities, nursing homes, MRI and PET scanners, in addition to those for additional services such as open-heart surgery and cardiac catheterization services for existing hospitals. Recently, our attorneys successfully guided a client through the complex regulatory process so that they could build and open one of only two new hospitals allowed in Mississippi since the CON laws took effect in the 1980s. Our experience is unparalleled when it comes to counsel on certificate of need issues.
At Gilchrist Donnell, we deal with HIPAA issues on a daily basis. For almost twenty years, we have provided our clients - both inside and outside of the healthcare industry — with the resources and advice they need to ensure complete compliance with the myriad rules and regulations that impact the privacy of individuals' health information. Whether you need a compliance plan as a covered entity or you are a business associate in need of tailored privacy policies and procedures to fit your current practices, we can provide for your every HIPAA-related need.
One of the most troublesome aspects of providing healthcare services comes in the form of reimbursements and post-payment audits. The Government's coding and billing regulations are complex and ever-changing. As every provider knows, mistakes happen, and while most errors can be corrected, those that go unnoticed can easily result in an audit. More and more often, audits appear with no warning, as Medicare and Medicaid contract with a multitude of third parties to data mine providers' claims. Unless handled appropriately from the outset, these audits can require an enormous expenditure of time and resources and derail a provider's attention to their patients' daily needs.
Whether from the RAC, ZPIC, MAC, MIC, or other entity, our attorneys have the experience and expertise to help clients efficiently navigate all types of Government audits and the appeal processes that sometimes follow. And perhaps most importantly, we have demonstrated extraordinary success on our clients' behalf in these matters.
Businesses and other organizations, which have not had to focus on healthcare, are now impacted by it in ways never imagined before 2010. For every healthcare provider and the vast majority of non-healthcare employers in the country, the Affordable Care Act has pushed the delivery and financing of healthcare to the forefront of budget considerations, and is occupying large amounts of valuable company time. We regularly assist employers in navigating the new mandates to provide employee and dependent coverage, and are continuing to partner with governmental agencies in various states to develop and implement regulations in response to Federal mandates. Our attorneys have the knowledge and expertise key leaders turn to when addressing the tangled web of Federal regulations.
The attorneys at Gilchrist Donnell regularly represent employers of all types and sizes throughout the southeast in a variety of employment litigation and regulatory matters. We take a proactive approach to address foreseeable problems at the start of the employment relationship by drafting or amending employee manuals or effectively negotiating contracts. However, if you are facing litigation in the EEOC or Federal Court from employees alleging some type of discrimination, or you are fighting disputes involving non-compete clauses, organized labor, or contract negotiations, our attorneys are equally adept at serving your needs.
In 1996, the passage of the Health Care Quality Improvement Act imposed more stringent requirements on hospitals and physician medical staff members in the conduct of peer review activities. Since then, Medicare, Medicaid, managed care companies and physician associations have all developed their own quality assurance and improvement standards. Failure by a facility or a physician practitioner to comply with these rules can result in exclusion from a Federal health care program, costly lawsuits, or both. The attorneys at Gilchrist Donnell regularly assist hospital and physician clients in drafting medical staff and governing board bylaws, rules, regulations and policies, as well as conducting peer review investigations and fair hearing processes.
Among the most active components of both our Federal and State Governments are the enforcement arms of the Medicare and Medicaid programs. Numerous laws are in place to prevent or ferret out fraud and abuse in these programs, and the penalties for non-compliance yield billions of dollars in recovery each year. As our population ages, and more pressures are put on funding these healthcare programs, fraud and abuse recovery efforts have proven to be the preferred method at keeping the government's money safeguarded. The physician prohibition on self-referrals (the "Stark" law), the Anti-kickback statute, the False Claims Act and the Civil Money Penalties law are weapons State and Federal prosecutors routinely use to combat the submission of improper claims to governmental programs.
Because the penalties for mistakes can be devastating, healthcare providers must make absolutely certain that all of their business relationships are compliant with state and Federal fraud and abuse laws. Providers that follow the best practices and are proactive when it comes to compliance risks have appropriate compliance plans. Compliance plans are those documents, which clearly set forth the risks a provider organization faces and outlines procedures to follow in order to avoid or rectify fraud and abuse concerns. Such plans are useful not only in demonstrating to an organization's workforce and business partners the intent of the entity to provide services with principled discipline, but to governmental officials who investigate instances of concern or actual violations of its intent to abide by the law.
No provider can bill for delivered healthcare in today's complicated billing systems without making some mistakes. When mistakes are made, providers are required to ensure they are corrected, which can mean anything from ensuring repeated actions do not occur, to repayment of claims or self-reporting violations to the government. Corrective action requires skill, experience and quick, thorough decision-making.
Our attorneys have particular expertise in fraud and abuse compliance. We have been intimately involved in the nuanced changes in fraud and abuse laws since their introduction. We routinely develop compliance programs specifically geared to each client's individual needs to help create deliberate practices that comply with the law. We work closely with clients who need to develop programs or relationships that achieve goals while maintaining compliance. Providing clients with solutions - not simply identifying the roadblocks — is our focus. We are trusted advisors who clients also look to when problems are too far advanced to rectify and self-reporting is required.
Our expertise in fraud and abuse issues is unsurpassed.
Companies sometimes have issues arise that are unusually sensitive. Whether it concerns criminal acts committed by employees or others while under the direction or control of a company's staff. Our attorneys have been called on to assist large and small businesses of all types deal with the most sensitive issues. We are adept at working with key leaders to gather and contain information, directing needed internal investigations, and working with law enforcement and other agencies to ensure that our client the public are protected.
Katie Gilchrist and David Donnell both began their practices handling large and small litigation matters in both State and Federal courts in Mississippi. Cases Katie and David have handled range from medical malpractice actions and basic contract disputes, to complex products liability cases and a vast array of employment discrimination claims. Both have accumulated many years of experience handling hard-fought court battles from the initial filing of the complaint or answer, to the conduct of jury trials, and through all available appeals.