Jacob J. Harper

Jake regularly manages all aspects of healthcare investigation and litigation matters, including responding to subpoenas and civil investigative demands from the US Department of Justice (DOJ), US Office of Inspector General (OIG), and US State Attorney General.

Jake’s deep understanding of the False Claims Act (FCA) enables him to combine his experiential knowledge of how FCA matters typically progress with detailed knowledge of Medicare and Medicaid coding and billing requirements—including evaluation and management (E/M) code scoring, ICD-10 and Current Procedural Terminology code elements, and application of National and Local Coverage Determinations (LCD).

Likewise, Jake represents providers, suppliers, and other stakeholders in conducting and resolving internal investigations, including those related to whistleblower complaints and audit findings. In this context, Jake also provides counsel on Medicare reporting and refunding obligations, as well as the OIG’s Anti-Kickback Statute and the US Centers for Medicare and Medicaid Services’ (CMS’s) Stark Law self-disclosures.

Finally, Jake is an accomplished administrative litigator, representing providers on appeals before the US Department of Health and Human Services’ (HHS’s) Office of Medicare Hearings and Appeals and Departmental Appeals Board and the CMS’s Provider Reimbursement Review Board.

As a former clerk for the OIG’s Office of Counsel to the Inspector General, Jake’s background in healthcare compliance grounds his practice.

Jake provides clients with a balanced, risk-based approach to compliance with legal requirements, taking into account historical enforcement trends with careful statutory, regulatory, and sub-regulatory analysis.

Jake also helps providers establish and update compliance programs, draft and adopt new policies and procedures, operationalize legal requirements within existing business structures and processes, and create, monitor, and respond to various compliance reporting mechanisms.

In addition, with extensive subject matter expertise, Jake advises clients on application of Medicare, Medicaid, and other payor policies, as well as state practice act and licensing considerations.

Bringing his in-depth knowledge of healthcare regulatory matters and structuring considerations, Jake is adept at supporting different types of clients with a wide range of healthcare and digital health transactions. He helps both structure and consummate deals.

Jake advises on corporate practice of medicine restrictions, friendly physician professional entity models, healthcare representations and warranties, and negotiating and enforcing indemnifications related to healthcare legal issues.

While typically representing purchasers and investors in the healthcare industry, Jake has also advised entities selling or recapitalizing their businesses. Jake also assists with change of ownership considerations surrounding state licenses, Medicare and Medicaid enrollment, and commercial payment contracts.

Litigation

• Conducting an internal investigation and preparing a Stark self-disclosure in connection with a health system’s provision of discounted rent and staff to a referring physician group
• Resolving a federal FCA investigation for a hospice system in the Eastern District of New York related to use of higher levels of care
• Resolving federal FCA investigations for hospice systems in both the Western District of Texas and the Eastern District of Virginia related to admission of patients potentially ineligible for hospice care
• Conducting an internal investigation for a national health system related to billing for heart ablation services and obtaining a full dismissal of a related FCA investigation
• Represents a substance abuse provider in connection with a subpoena issued by the Massachusetts Office of the Attorney General related to evaluation and management (E/M) and urine drug screen services
• Represents an orthopedic and neurology surgical practice in connection with a DOJ subpoena alleging various Medicare billing errors
• Represents hospices, home health agencies, and health systems throughout the United States on Medicare appeals, which includes responding to supplemental Medical review contractors and unified program integrity contractors, filing redetermination and reconsideration appeals, hearings before Administrative Law Judges, and appellate proceedings before the HHS’s Medicare Appeals Council

Regulatory Compliance

• Advises a global technology company in connection with the provision of telemedicine services and related diagnostic and laboratory services throughout the United States
• Counsels a national pharmacy on development and implementation of its process for identifying credible information and investigating the need to make refunds in connection with the Medicare 60-Day Rule
• Advises a national provider of food services on state requirements regarding the practice of telehealth services for licensed nutritionists and registered dieticians
• Provides ongoing counsel to a national hospice, home health, and personal care services agency in connection with Medicare, Medicaid, and Veterans Benefits Administration billing requirements, and related overpayment reporting and refund activities
• Assists a national provider of transcranial magnetic stimulation therapy with Medicare supervision requirements and LCD compliance requirements

Mergers, Acquisitions, Transactions, and Joint Ventures

• Represents a national insurance company in venture capital investment in digital health and service organization startups
• Leads a team advising a publicly traded pharmacy and digital health technology company in connection with a sale to a private strategic buyer, including change of ownership licensing issues
• Represents a US private equity fund on its purchase and disposition of hospice and home health organizations, as well as rollup acquisitions to establish regional healthcare platforms
• Represents a not-for-profit hospice in its merger with another not-for-profit hospice, including federal and state change of ownership and audit considerations
• Represents a national private equity fund in the purchase and rollup of various physician groups in the emergency, vision, orthopedic, and primary care areas
• Represents a national home health and hospice organization in connection with joint ventures with other healthcare stakeholders
• Negotiating an indemnification right associated with identified Medicare overpayments and advising the purchaser on enforcement issues