Rachel Carey

Counsel
blank image Rachel Carey

Rachel Carey

Counsel
Richmond T: 804.793.8639 F: 804.793.8644
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Rachel Carey

Rachel Carey

COUNSEL
rcarey@whitefordlaw.com
RICHMOND
T: 804.793.8639
F: 804.793.8644
Biography
BIOGRAPHY
Ms. Carey's practice spans the health care landscape, with a particular focus on regulatory compliance, reimbursement and related health care issues. She provides clients with practical and value-additive counsel, leveraging her extensive legal experience and background working at managed-care organizations to offer key insights into developing best reimbursement practices. She regularly works with various health care providers, from independent practitioners and start-ups to large health systems, long-term care providers, and substance abuse treatment and behavioral health providers.

Ms. Carey's practice extends to drafting policies and procedures for health systems and academic medical centers, including different state life-sustaining treatment and graduate medical education policies. She is regularly called upon to address health system issues requiring a deep technical knowledge of health care programs, such as COVID and telemedicine flexibilities, CMS waiver appeals and adding new service lines to comply with enrollment regulations.

Her expertise spans corporate practice of medicine and fee-splitting statutes, federal and state Anti-kickback statutes, self-referral regulations and compliance with EMTALA and HIPAA, providing clients with comprehensive legal support and proactive compliance oversight in an ever-evolving regulatory environment. Additionally, Ms. Carey advocates for clients in various regulatory proceedings, ensuring their interests are protected throughout the process.


Recognitions

  • Virginia Lawyers Weekly, Healthcare Law "Up & Coming" (2024)


Memberships & Activities

  • Member: American Health Lawyers Association
  • Member: American Bar Association, Health Law Section
  • Member: Virginia Bar Association
  • Member: Florida Bar Association, Health Law Section
  • Assisting with the application of COVID and telemedicine flexibilities, CMS home and community-based waiver participant appeals and grievances. 
  • Ensuring compliance with CMS enrollment regulations and state licensure laws.
  • Navigating complex regulatory landscapes to ensure compliance with corporate practice of medicine, Anti-kickback statutes, self-referral laws and telemedicine regulations.
  • Drafting physician contracts and compensation packages to meet regulatory requirements.
  • Conducting assessments and mitigating business practices against applicable regulations for Medicare and Medicaid managed care plans.
  • Advising specialized Medicare managed care plans, such as C-SNPs and DSNPs, and drafting provider and vendor contracts, marketing materials, compliance plans and corrective action plans.
  • Representing providers and managed care plans in challenging enforcement actions and audit findings, from State Licensing Board hearings to Administrative Law Judge hearings.
  • Managing regulatory reporting requirements for individual providers, health care facilities and managed care plans.
  • Handling mandatory reporting obligations for health systems, including practitioner actions under peer review, FDA reporting for malfunction devices, reporting to ACGME, state license renewals and Medical Loss Ratio reporting.
INSIGHTS
Speaker: "Palliative Care Programs: Where to Start and How to Maintain Them,” (Virtual Annual Conference for the Virginia Association for Home Care and Hospice, November, 2024)

Speaker: "Palliative Care Programs,” (LifeSpan Maryland Conference, September 25, 2024)

Speaker: "Legal Consideration for AI in Health Care,” (American Alliance of Orthopedic Executives Virtual AI Summit, August 28, 2024)

Author: Summary of Medicare Advantage, Part D Rate Changes for CY 2025 (American Health Law Association, 2024)

ARTICLES

November 11, 2024

Understanding IRS Encouragement of PLRs for Healthcare Entities and Assessing Healthcare Corporate and Tax Structure For Tax Compliance

The IRS has recently been urging healthcare entities, particularly those involving physicians and private investors, to seek private letter rulings (PLRs) to clarify the tax implications of their ownership structures. This encouragement comes in light of the complexities and ambiguities surrounding the "friendly doctor" or "friendly PC" models, where a physician-owned professional corporation (PC) is managed by a separate management service organization (MSO).
October 31, 2024

Preparing For 2025 Stark Enforcement Regarding Compensation and Productivity Bonuses

In 2024, Stark Law enforcement remains a critical focus for healthcare providers and regulatory bodies, with a continued focus on excessive compensation and productivity bonuses. Compliance with Stark Law is essential to avoid significant penalties, including repayment obligations, civil monetary penalties, and potential exclusion from federal healthcare programs.
August 1, 2024

Corporate Practice of Medicine, Antikickback and Stark Analysis After the AAEM-PG and Envision Settlement

The American Academy of Emergency Medicine Physician Group (AAEM-PG) recently settled a lawsuit in United States District Court for the Northern District of California against Envision Healthcare and Envision Physician Services, accusing them of violating the corporate practice of medicine (CPOM) laws in California.[1] The lawsuit alleged the “friendly physician” model used by Envision to control medical practices through management services agreements interfered with the medical judgment and autonomy of the medical entities Envision served. The model is commonly used in physician practice transactions with private equity investors.[2] The suit was unusual in that it was a private entity, not a government entity, requesting relief and asked the court to find models and those alike illegal in California.

 
July 17, 2024

CMS Releases Final Part Two Guidance of the Medicare Prescription Drug Payment Plan

The Department of Health and Human Services (HHS), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is striving to alleviate the financial strain of medication costs on the elderly and disabled populations who rely on Medicare with the Medicare Prescription Drug Payment Plan. CMS has released final part two guidance for CY 2025 on July 16, 2024, to prepare stakeholders for its implementation.
July 2, 2024

What Providers Need to Know About the CMS Interoperability and Prior Authorization Rule

The article provides an overview of the CMS Interoperability and Prior Authorization final rule and its implications for different types of providers. It summarizes the main requirements and deadlines for the rule, which aims to improve the efficiency and transparency of healthcare delivery by requiring the use of standardized APIs for data exchange among payers, providers, and patients. 
May 7, 2024

New HHS Final Rule and DOJ Proposed Rule Take Aim to Eliminate Further Discrimination Against People with Disabilities in Healthcare

On May 1, 2024, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), finalized a rule that prohibits discrimination on the basis of disability. This rule (“Final Rule”), titled Discrimination on the Basis of Disability in Health and Human Service Programs or Activities, more explicitly and specifically provides protections for people under Section 504 of the Rehabilitation Act (Section 504).
April 26, 2024

Summary of New CMS Minimum Staffing Standards for Long-Term Care Facilities and Institutional Payment Transparency

Even after a large amount of industry pushback, CMS issued the final rule for minimum staffing requirements and institutional payment transparency for long-term care (LTC) facilities. While stakeholders have indicated that the rule could put more pressure on current staff and lead to further workforce burnout, CMS insists the regulations are needed to ensure safety of the nation’s vulnerable populations.
April 23, 2024

Summary of New CMS LTC Facility Staffing Mandates

Even after a large amount of industry pushback, CMS issued the final rule for minimum staffing requirements and institutional payment transparency for long-term care (LTC) facilities.
April 2, 2024

Client Alert: New HHS and CMS Guidance on Informed Consent for Sensitive Examinations and Best Practice for the Informed Consent Process

Centers for Medicare & Medicaid Service (CMS) revised hospital interpretive guidance in the State Operations Manual, Appendix A-Hospitals on April 1, 2024 in response to media stories of nation’s teaching hospitals and medical schools repeatedly performing sensitive examinations while under anesthesia without informed consent. Highlighted sensitive exams include but are not limited to pelvic, breast, prostate, and rectal examinations. The new guidance is effective immediately.
February 26, 2024

New CMS Guidance on Use of Algorithms and AI in Prior Authorizations and Utilization Management

Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that don’t match plan-determined diagnosis or that denied payment for post-acute care that exceed AI-predicted lengths of stays. The criticism has been that these decisions are not based on proper criteria or made in compliance with regulations.
December 13, 2023

Combating Healthcare Workplace Violence

Violence against healthcare workers has been a steadily growing concern. The industry is working towards addressing these dangers. 
 

PRESENTATIONS