Regulatory Compliance

The healthcare industry is heavily regulated at the federal and state levels. Federal laws such as the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic Clinical Health Act (HITECH), the Emergency Medical Treatment and Labor Act (EMTALA), the physician self-referral law, known as the Stark law, the Anti-kickback statute, and the False Claims Act, to name a few, touch upon virtually every segment of the healthcare industry. Most states, including New Mexico, impose their own regulatory framework on top of federal rules and regulations, making it challenging for providers and healthcare entities to achieve 100% compliance in all areas of federal and state law.

 Dan represents providers and healthcare entities in matters involving healthcare regulatory compliance. His experience in this area includes handling questions about HIPAA, including evaluating when PHI has been compromised and determining what level of notification is required under the breach notification rules. Dan has fielded questions about EMTALA throughout his career and advised hospitals on the ins-and-outs of EMTALA compliance. 

 Dan also advises providers about whether proposed business arrangements run afoul of the Stark law or trigger liability under the Anti-kickback statute. He has prepared legal opinions regarding whether a proposed business arrangement complies with New Mexico’s specific regulatory framework as it relates to physician referrals and kickbacks. Although New Mexico does not have a “mini” Stark or AKS law like many states, it does regulate referral schemes and kickbacks at the licensing level. 

 Dan also defends healthcare entities and physicians in matters involving government investigations and prosecutions where federal or state authorities allege fraud, misrepresentation, and alleged violations of the False Claims Act or Civil Monetary Penalties statute. These cases can be particularly challenging, especially when they trigger simultaneous criminal investigation or scrutiny. When these cases arise, it is also critically important to consider when a provider has an obligation to report the investigation or allegation to licensing authorities. Failing to report adverse actions can result in parallel administrative prosecutions, which can be a nightmare stacked on top of ongoing civil and criminal proceedings.