Colin P. McCarthy Counsel

Colin helps healthcare providers navigate the intricate maze of regulations governing the healthcare industry, with a focus on health care reimbursement, audits and investigations, HIPAA, and licensing, enrollment, and certification issues.

Colin’s practice focuses on advising healthcare providers and suppliers on the complex regulations governing reimbursement from Medicare, Medicaid, and other federal and private payers.  Hospitals, health systems, surgery centers, physician practices, home health agencies, behavioral health and addiction treatment providers, pharmacies, durable medical equipment suppliers, and other healthcare providers and suppliers benefit from Colin’s significant experience and efficient, practical advice on a variety of reimbursement and compliance issues, including: billing and coding, overpayments and self-disclosures, reimbursement disputes, exclusions, government audits and investigations, changes of ownership, Medicare Conditions of Participation and Conditions for Coverage, provider-based status, HIPAA, the False Claims Act, Stark and Anti-Kickback laws, development and implementation of compliance programs, and other regulatory compliance issues. 

In healthcare transactions, Colin counsels clients on thorny regulatory issues identified in due diligence, and advises on strategies to mitigate potential risks, including submissions of voluntary refunds, self-disclosures, and advisory opinion requests to the Office of Inspector General (OIG).  Colin has extensive experience working with the Centers for Medicare and Medicaid Services (CMS), state Medicaid agencies, accreditation bodies, and state licensing agencies across the country on enrollment, accreditation, licensure, and certification issues.  He leverages his contacts and experience to help clients structure transactions and operations to minimize business disruptions and assists clients with the associated regulatory filings with federal and state agencies.

Colin frequently writes and presents on emerging reimbursement and compliance issues and is active in the American Health Lawyers 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.  In 2018-2020, Colin was recognized by Super Lawyers as a "Virginia Rising Star” in healthcare law.

Experience

Represented academic medical center in ALJ hearing before the Office of Medicare Hearings and Appeals (OMHA) in a significant overpayment dispute.

Represented an academic medical center in Medicaid appeal regarding high-dollar claim denial.

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.

Represented multiple physician practices in OIG self-disclosures and settlements regarding incident-to billing.

Represented health system in OIG self-disclosure and settlement regarding excluded individual.

Represented physician practices in CMS Self-Referral Disclosure Protocol submissions.

Represented of healthcare providers in requesting advisory opinions from the OIG.

Represented national ASC management company in regulatory filings and approvals for acquisitions of multiple ASCs.

Led the regulatory filings and approvals process for a health system in acquisition of two hospitals.

Led the regulatory filings and approvals process for multiple acquisitions of physician practices, pharmacies, DME suppliers, and physical therapy practices.

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

  • 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

  • Speaker, "2019 Medicare and Medicaid Year In Review," AHLA Institute on Medicare and Medicaid Payment Issues, March 25, 2020
  • 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
  • Virginia

Named to "Virginia Rising Stars," Health Care, Super Lawyers, Thomson Reuters, 2018, 2019, 2020

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