Colin P. McCarthy Associate

Colin concentrates his practice on healthcare compliance and reimbursement.  He counsels hospitals, health systems, surgery centers, physician practices, and other healthcare providers on the laws and regulations governing payment from Medicare, Medicaid, TRICARE, and commercial payers.

He advises healthcare clients on coverage, coding, and payment rules; Medicare Conditions of Participation; provider-based status; HIPAA; False Claims Act and “60-Day Rule;” Stark and Anti-Kickback laws; development and implementation of compliance programs; and other regulatory compliance issues.  Colin frequently helps healthcare providers undergoing changes of ownership or reorganizations navigate the state licensure, Medicare enrollment and certification, and other regulatory filings necessary to complete the transaction with minimal disruption to business operations.

Colin also represents healthcare providers facing scrutiny from government auditors and investigators, including Recovery Audit Contractors, Zone Program Integrity Contractors, state Medicaid programs, the Office of Inspector General, and the Department of Justice.  He has defended providers in dozens of administrative appeals of adverse audit results.  He also helps healthcare providers mitigate their False Claims Act risk by conducting internal compliance investigations and preparing self-disclosures to the government when necessary.

Colin frequently writes and presents on emerging reimbursement and compliance issues and is active in the American Health Lawyers Association and Health Care Compliance Association. Colin maintains an active pro bono practice through the Legal Information Network for Cancer, using his understanding of healthcare reimbursement to assist cancer patients with coverage and payment issues.

Experience

Represented dozens of healthcare providers in administrative appeals of Medicare, Medicaid, and commercial payer audits.

Advised hospitals through the Medicare certification process, including initial certification and additions of provider-based departments, hospitals-within-hospitals, and distinct part units.

Served as interim Compliance and Privacy Officer for a community hospital.

Counseled health care clients on the application of fraud and abuse laws, including Stark, Anti-Kickback Statute, False Claims Act, and Civil Monetary Penalties Law.

Conducted internal investigations and prepared self-disclosures to Medicare and Medicaid programs.

Represented hospital in successful appeal of CMS’ termination of sole community hospital status.

Represented hospital in successful appeal of CMS’ termination of Critical Access Hospital status.

  • William & Mary Law School, JD, Member, William & Mary Law Review, 2010
  • Christopher Newport University, BA, 2007

Vice Chair, American Health Lawyers Association Accreditation, Certification, and Enrollment Affinity Group, 2016 – present

Pro Bono Attorney, Legal Information Network for Cancer, 2015 - present

Member, American Health Lawyers Association

Member, Health Law Section, Virginia Bar Association

Member, Health Care Section, Virginia State Bar

Member, Health Care Compliance Association

Member, Healthcare Financial Management Association

  • Co-author, "CMS’ Role in Hurricane Disaster Relief Efforts", The RAP Sheet, December 2017
  • Author, CMS Provides Waivers in States Affected by Hurricanes Harvey and Irma , McGuireWoods Legal Insights, September 20, 2017
  • Author, CMS Open Payments: A Look Behind the Curtain, McGuireWoods Legal Insights, July 5, 2017
  • Author, Increased Focus on Health Care Cybersecurity: HHS Releases Long-Awaited Report and Cyber Attack Quick-Response Checklist, Password Protected, June 29, 2017
  • Author, "Do We Have an Overpayment? How the 60-Day Rule and Escobar Impact a Compliance Investigation", Bender's Health Care Law Monthly, February 2017
  • Co-author, "Distinct Part Units", AHLA Representing Hospitals and Health Systems Handbook, September 2016
  • Co-author, "CMS Aims To Curb Hospital Access To Provider-Based Billing", Law360, July 2016
  • Author, "The Final 60-Day Rule is Here: What Healthcare Providers Need to Know", HCCA Compliance Today, May 2016
  • Author, "First 60-Day Rule Enforcement Cases Unfavorable To Healthcare Providers", HCCA Compliance Today, November 2015
  • Co-author, "The Risky Business of Co-Location Arrangements", AHLA Connections, March 2015
  • Author, "Managing the Medicare Prepayment Review Process", Virginia Health Care Association Legal Quarterly, December 2014
  • Co-author, "Responding to CMS Overpayment Demands: Practical Steps for Appeal", ABA Health Lawyer, August 2014
  • Co-author, "Understanding the 60-Day Repayment Rule", Advisory Board Law Review, January 2014
  • Co-author, "The Potential Impact of the Fiscal Cliff Deal on Provider Audits", Advisory Board Daily Briefing, February 2013
  • Author, "Medicare's Secret Weapon in the Fight Against Fraud", Virginia Medical Law Report, September 2012
  • Author, "Paging Dr. Google: Personal Health Records and Patient Privacy", 51 William & Mary Law Review 2243, May 2010
  • Virginia
  • Speaker, "Best Practices for Responding to Medicare Claims Audits and OIG Compliance Audits," Healthcare Litigation and Compliance Webinar Series, March 22, 2018
  • Speaker, "Year in Review," Institute on Medicare and Medicaid Payment Issues, March 2017
  • Co-presenter, "Provider-Based Status: Recognizing Evolving Compliance Risks and Remembering the Fundamentals," American Health Lawyers Association Fraud & Compliance Forum, October 2016
  • Co-presenter, "Developing and Implementing Hospital Capital Projects," Virginia Hospital & Healthcare Association, March 2016
  • Presenter, "Healthcare Regulation," Virginia Commonwealth University eMBA Program, June 2015
  • Co-presenter, "Structuring Healthcare Co-Location Arrangements," Strafford Webinar, June 2015
  • Moderator, "Hospital Co-Location," American Health Lawyers Association Webinar, May 2015
  • Co-presenter, "Inpatient or Observation? Practical Advice for Hospitals on Compliance with CMS' 'Two Midnight' Benchmark," Healthcare Financial Management Association VA/DC Spring Education Conference, March 2014
  • Co-presenter, "Payer Audit, Enforcement & Compliance: Are You a Target," Medical Group Management Association Virginia Chapter, December 2013
  • Co-presenter, "A New Era of Government Enforcement: Strategies for Preparing for and Responding to Government Audits," Health Care Compliance Association Clinical Practice Compliance Conference, October 2013
  • Co-presenter, "Avoiding Costly Medicare Enrollment Errors," Healthcare Financial Management Association VA/DC Summer Conference, August 2011
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