Services & Practice Areas

Healthcare

The healthcare industry has an ever-expanding effect on today's economic culture. The Medicare Program alone is the second-largest federal program in the U.S., and questions regarding its sustainability continue to grow. Due to the dollars at risk, it is no surprise that those responsible for maintaining the integrity of both government and commercial healthcare programs seek to protect those funds, increasing the use of investigations, audits, and other recovery process tools. 


Mr. Lawhon uses his unique experience to guide clients in understanding the myriad of complex laws, regulations,and rulings that govern the delivery of healthcare services. Whether it be providing advice on regulatory compliance, assisting with payor audits or investigations, or conducting a risk assessment of a client's practice, the M B Lawhon Law Firm can provide experienced counsel to help clients with their healthcare practice needs.

Regulatory Compliance

The Regulatory Compliance practice area helps clients identify, address, and resolve issues relating to adherence to the rules and regulations governing delivery of healthcare services. The M B Lawhon Law Firm provides effective strategies for addressing compliance gaps or assistance for updating and strengthening existing compliance policies. 


Counsel on compliance matters includes:

  • Operational and/or contractual issues that could implicate fraud or abuse laws, such as Anti-Kickback, Stark, False Claims Act, and Sunshine Act
  • Federal healthcare programs, including Medicare, Medicaid, and DOL-FECA
  • Handling of self-identified overpayments
  • State licensing issues
  • Privacy and security provisions of HIPAA
  • CPT, HCPCS, ICD 9/10 coding & reimbursement issues

Government or Payor Audits & Investigations

Each year, the scrutiny upon those in the healthcare industry becomes greater and greater. Law enforcement agencies at both the federal and state level have teamed up to combat fraud simultaneously through healthcare fraud task forces (HEAT). The Department of Health and Human Services Office of Inspector General has increased its data analytics capabilities and partnered with private insurance carriers to share data for the purpose of better identifying fraud trends (HFPP). CMS is constantly evaluating its Contractors to make certain they are performing their due diligence in protecting the integrity of the Medicare Trust. In this intense investigatory climate, the M B Lawhon Law Firm offers healthcare providers a rare attorney, who has not only quality legal training, but also experience in conducting the exact types of audits and investigations to which clients may find themselves subject. Applying his unique knowledge and experience, Mr. Lawhon helps clients at every step of the audit or investigative process. Audits and investigations clients may receive help for:

  • RAC, MAC, or ZPIC audits
  • Medicare or Medicaid payment suspensions
  • Single-state Agency (Medicaid) audits
  • Tricare and DOL audits
  • DOL
  • MFCU investigations
  • False claims investigations

Risk Assessment & Internal Investigations

While promptly responding to audit or investigative demands is important, many times a proactive approach to understanding healthcare practices can prevent the unwanted attention in the first place. With increased reliance by law enforcement and payors on data analytics, it is important to hire an attorney with extensive data mining and investigative analytics experience. The M B Lawhon Law Firm can conduct an internal investigation of a healthcare practice, including claims submitted to payors, and provide an opinion of the provider's potential for review by regulatory or law enforcement agencies. If issues or overpayments are identified, Mr. Lawhon will counsel clients on the best course of action, while maintaining confidentiality and privilege.