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Colin P. McCarthy Counsel

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Richmond T +1 804 775 7819 F fax +1 804 698 2094
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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.