Sam Canales is an associate in the Corporate Practice Group in the firm's Washington, D.C. office and a member of the Healthcare Industry Team.
Areas of Practice
Sam draws from his deep regulatory and litigation background to provide legal and practical business counsel to clients across the healthcare and life sciences industries.
Sam focuses on issues relating to healthcare fraud, waste, and abuse, including state and federal self-referral, anti-kickback, and false claims authorities. He develops compliance programs; conducts internal investigations; assists in voluntary disclosures; responds to government actions; negotiates corporate integrity agreements; defends against civil fraud and qui tam litigation; and helps clients respond to grand jury subpoenas and search warrants.
Sam has particular experience working on issues pertaining to mental healthcare providers, including licensing / certification, recognition programs, marketing, telemental health, records, privacy, billing, and payment. In recent years, Sam has played a lead role in over fifty matters addressing the impacts of state and federal legal reforms on the mental healthcare arena.
Sam also specializes in counseling healthcare plans, administrators, and managers on topics relating managed care organizations, including Medicare and Medicaid issues. He holds a strong understanding of licensing, accreditation, exchanges, eligibility, benefit design, ratings, networks, risk adjustment, claims processing, audits, reporting, and payment methodologies, such as innovation models developed by the Centers for Medicare & Medicaid Services.
Sam is especially versed in evaluating healthcare payer operations through comprehensive economic and risk analyses, including detailed assessments of premium intakes, member cost-sharing, risk pools, service utilization, quality of care, network adequacy, coding, claims inventories, medical necessity, surpluses / reserves, payment methodologies, and medical loss ratio calculations.
Before joining the firm, Sam was a healthcare associate at a national law firm, and a healthcare attorney at the Office of the New York State Attorney General. While in public service, Sam worked on numerous high-profile enforcement actions aimed at expanding patient access to mental healthcare services.
During law school, Sam volunteered at the Cancer Legal Resource Center, clerked at a healthcare law firm, and participated in externships at the California Department of Insurance and a federal court. Sam also previously served in the California Governor’s Office, where he worked on initiatives to improve healthcare equity.