Karie Rego

Karie Rego is a special counsel in the Corporate Practice Group in the firm's San Francisco and Palo Alto offices.

Areas of Practice 

Karie specializes in health care reimbursement, audits, investigations and regulatory compliance.  She spent twelve years at Jones Day and McDermott, Will & Emery where she was a partner in their healthcare department.  Karie then took her expertise and worked for several years in-house at one of the largest non-profit health systems in the country.  In her in-house position, she worked on many projects to (i) increase system-wide compliance as well as quality and reimbursement (ii) identify and reduce reimbursement and investigation risk and (iii) respond to and work with state and federal regulators conducting external audits.  Karie currently provides advice to health care providers, plans, medical device and related companies.           

Karie has settled or worked on the dismissal of over fifty OIG and qui tam relator cases.  Her research was instrumental in ending the Office of Inspector General's national laboratory unbundling investigation.  She is one of only a handful of attorneys in the country that have deep reimbursement experience which is enhanced by her unique status as a certified coder.  Because of her experience in investigations, audits, reimbursement and regulatory compliance, Karie has a unique ability to quantify the risk of reimbursement and regulatory compliance issues, create targeted and effective internal audits and identify novel arguments when negotiating with the government and payers.

Reimbursement

Karie provides advice to all types of health care providers including hospitals, physicians, nursing homes, home health and hospice providers, laboratories and durable medical equipment companies.  Karie also has advised plans, medical device companies, investors and others in the health care industry on reimbursement issues.

Karie is particularly focused on helping clients identify opportunities to reduce risk while improving reimbursement and patient care.  She has helped health systems, for example, better understand coding, documentation and order requirements and communicate those requirements throughout the system.  Karie also has structured physician compensation arrangements to incentivize quality-based goals in line with the health reform changes in reimbursement and ACO creation.

General Compliance

Karie can help draft and review compliance plan programs, policies, education and audit materials.  Karie's investigation and reimbursement background results in her being able to identify and mitigate risks that others might not understand.  Karie also has a strong background in working through issues related to physician referral prohibitions, EMTALA and other quality based issues and licensure questions.

Audits and Investigations

In the area of audits and investigations, Karie takes a thoughtful and measured approach to:

• Designing internal audits to identify areas that need correcting without creating future litigation risk from poorly conceived and drafted audit protocols.
• Narrowing document requests and creating compelling and coordinated responses to RAC, ZPIC and Medicaid audits.
• Responding to private payer inquiries and document requests and negotiating repayments.
• Conducting internal investigations

Karie has negotiated settlements and won dismissals in cases involving the OIG, U.S. Attorney’s Office, State Attorney General’s Offices and whistleblowers on a myriad of issues including physician relationships, medical devices, coding issues, laboratory, ambulance and durable medical equipment billing, physician supervision and certifications, medical necessity and cost reporting issues.

Education

• J.D., Boston College, 1993
• M.S., Finance, Boston College Graduate School of Management, 1994
• A.B., Assumption College, 1990

Admissions

• California
• District of Columbia
• Massachusetts

Memberships

• American Academy of Professional Coders
• Certified Professional in Healthcare Quality
• Health Care Compliance Association
• American Health Lawyers Association

Articles

Healthcare Law Blog articles

• "Payment Safeguards for Provider Managed Care Arrangements," June 27, 2012
  
• "Managing an Internal Audit," May 1, 2012
• "New Medicare Advantage Audits Likely to be Challenging for and Challenged by Providers and Plans," February 27, 2012
• "How Compliance Programs Can Really Reduce Risk," February 23, 2012
• "How to Prepare for a Search Warrant," January 19, 2012
• "Observation Services at Risk Once More," December 14, 2011
• "Termination from Medicare and Medicaid Programs Due to Confusion Over Standards," October 24, 2011
• "Quality, Reimbursement and the Medical Staff," July 15, 2011
  
   

Speeches

• HCCA Annual Meeting, April 2010, Delivering Powerful Compliance Messages in Web, Print and Video
• AHLA Fundamentals, November 2005, Researching Health Law Issues and Medicaid Update
• AHLA Institute of Medicare and Medicaid Payment Issues, March 2004, Researching Medicare and Medicaid Issues
• American Radiologists Association, August 2002, Health Care Fraud Actions
• University of California San Diego Medical Record Keeping Course, April 2002 and October 2004, The Law and the Medical Record
• Volunteer Hospital Association, June 2001, OPPS Update