Paula G. Sanders

Paula G. Sanders is a Principal and Chair of the Firm's Health Care Practice Group, where she focuses her national practice exclusively on health care law. She represents clients on both substantive and procedural aspects of health facility regulation, such as licensure and certification surveys, compliance, Medicare/Medicaid, payment matters, HIPAA, fraud and abuse, False Claims Act investigations, and voluntary disclosures. She works closely with clients who find themselves in the cross-hair of government focus and assists with real-time responses to immediate jeopardy events and other crises. She vigorously advocates for her clients before multiple regulatory and law enforcement agencies and is especially successful at coordinating an integrated response to her clients’ issues.

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• Conducted internal investigation for non-profit hospice regarding potential documentation issues supporting eligibility, length of stay and medical necessity. Investigation resulted in a voluntary disclosure to Department of Justice (DOJ) and Office of Inspector General (OIG) of approximately $10 million with no corporate integrity agreement. Estimated cost avoidance for provider in excess of $75 million.
• Negotiated favorable settlement with the DOJ and OIG with nominal repayment and no corporate integrity agreement. The case involved a national nursing home chain in alleged worthless services quality of care investigation. - Obtained $1.2 million recovery for Medicaid providers who challenged cost report audit findings.
• Successfully settled with contracted therapy company for indemnification of certain damages, significantly reducing provider’s financial exposure. The case involved a multi-state skilled nursing provider in a Zone Program Integrity Contractor (ZPIC) investigation of alleged ultra-high therapy overutilization.
• Prevented closure of a personal care home whose license had been revoked. The process included successful appeal and settlement of underlying allegations, resulting in continued operation, rescission of civil money penalties and return to full licensure.
• Developed compliance and ethics program for multi-state institutional pharmacy provider. Trained staff about Stark and Anti-Kickback risks related to marketing and pricing.
• Represented client in voluntary disclosure to OIG concerning unknowing employment of an excluded nurse. OIG sought recovery in excess of $500,000: case was resolved for $265,000.
• Assisted mental health and developmental disability (behavioral health) provider with internal investigation and submission of voluntary self-disclosure to state Bureau of Program Integrity regarding insufficient documentation to support certain claims, thus avoiding potential penalties.
• Achieved relief for national health system from threatened closure of certain inpatient services provided in outpatient clinics through negotiations with state licensure agency. - Won an independent dispute resolution (IDR) challenging a nursing home deficiency alleging improper care that had been cited as causing widespread harm.
• Successfully defended a home-health agency undergoing Program Safeguard (PSC) audit, avoiding many adverse findings.
• Represented individual providers (including nurse, chiropractor, physician, social workers and dental assistant) in demonstrating good cause to the OIG for declination of permissive exclusion related to professional licensure actions.
• Responded to internal hotline complaints about alleged therapist misconduct at skilled nursing facility, resulting in internal investigation and voluntary disclosure to OIG. Prevented filing of qui tam lawsuit by working with complainant to resolve allegations.
• Challenged and obtained removal of immediate jeopardy citations and penalties arising from CMS survey of hospital-affiliated skilled nursing facility.
• Challenged CMS policy regarding citation of immediate jeopardy for glucometer usage, resulting in removal of immediate jeopardy citation for client and revision of national policy.
• Represented hospital radiology department before Pennsylvania Department of Environmental Protection and negotiated settlement regarding mammography services.
• Assisted national chains (hospitals, nursing homes, hospices, home health agencies, laboratories, and pharmacies) undergoing corporate reorganization or traditional changes of ownership with Medicare, Medicaid, and state licensure CHOW processes, including completion of appropriate CMS 855 forms.
• Advised management company about potential Stark issues related to certain physician arrangements and contracts.
• Avoided a formal case being opened after learning of a preliminary investigation of alleged quality-of-care issues at a regional nursing home by contacting U.S. Attorney’s Office and advising of our representation, resulting in timely discussions with client and investigators.
• Organized coalition of nursing home trade associations to assist state in development of a more user-friendly policy regarding the reporting and financial ramifications of preventable serious adverse events.

• "HHS Releases Nursing Home Owner, Manager Disclosure Rule," Law360, November 15, 2023
• "Nursing Homes Must Prepare For Ownership Scrutiny," Law360, August 8, 2023
• "Nursing Homes’ Medical Directors Should Prepare for New Expectations," coauthored with M.L. Mattioli, PMDA e-News, July 2023
• "Courts Halt CMS Vaccine Rule, But ‘It’s a Very Fluid Situation’ " Report on Medicare Compliance, Volume 31, Number 43 (December 6, 2021)
• "Infection Control Rules For Nursing Homes Are Too Strict," Law360 (January 26, 2020)
• "Prepare For CMS Scrutiny Of Nursing Home Infection Surveys," Law360 (June 12, 2020)
• "Nursing Homes Shocked at 'Insanely Wrong' CMS Data on COVID-19," MedPage Today (June 9, 2020)
• "Survey and Documentation Requirements Present Challenges to LTC During Pandemic," Society for Post-Acute and Long-Term Care Medicine (PMDA) (June 2020 Newsletter)
• "Universal coronavirus testing at Pennsylvania nursing homes? Some say it’s ‘an idea without a plan.’" Philadelphia Inquirer (May 14, 2020)
• "From Dorms to Tents, Hospitals Adapt for COVID-19; Some Patients Are Stuck," Report on Medicare Compliance, Volume 29, Number 18 (May 11, 2020)
• "Questionable Survey Enforcement Policies Require Heightened Preparation," PADONA Newsletter (January 2017)
• “Get Ready for Increase in CMPS; Stakes are Raised for Compliance,” Report on Medicare Compliance (September 12, 2016)
• "Surveyors Will Request And Review Policies and Procedures that Prohibit Staff from Taking, Keeping, and/or Distributing Photographs that Demean or Humiliate Residents Starting September 5, 2016," PADONA Newsletter (September 2016)
• "New Rules for Practitioners," PADONA Newsletter (June 2016)
• Quoted in, "Hospital Settles Case Over Free Discharge Planning
  from Home Health Agencies," Report on Medicare Compliance (May 2, 2016)
• Quoted in, "SNF Therapy Contractor Settles for $125M, but SNFs Settle Too," Report on Medicare Compliance (January 18, 2016)
• Featured in, "Staying on the right side of compliance," by Elizabeth Leis Newman, Senior Editor, McKnight's (October 9, 2015)
• Quoted in, "OIG alert hints at increased scrutiny over health IT data blocking," by Lisa Schencker, Reporter, Modern Healthcare (October 8, 2015)
• "CMS Releases New Civil Money Penalty Analytic Tool for Survey Deficiencies Which Can Result in CMPs Exceeding $100,000," PADONA Journal (January-April 2015)
• "Expert says providers often wrongly threatened by PEPPER reports," McKnight's Long Term Care News (October 21, 2014)
• "Coming Soon: Electronic PEPPER Reports," PADONA Journal (May-August 2014)
• "Government Focus on Quality of Care Highlights Need for Greater Director Involvement in Quality Assurance," Pennsylvania's Association for Long Term Care Medicine (PMDA) Spring 2014 Newsletter (May 1, 2014)
• "Compliance guide to PEPPERs for skilled nursing facilities," HCCA's Compliance Today (March 2014)
• "New Changes to Clinical Lab Act May Affect Nursing Homes," PADONA Journal (January-April 2014)
• "CMS Lays Out RAC Changes That Will Occur When Program Resumes," Inside CMS, Vol. 17, No. 9 (February 27, 2014) 
• "How RAC Pause Will Affect Therapy Manual Medical Reviews Is Unclear," Inside CMS, Vol. 17, No. 9 (February 27, 2014) 
• "Recovery audits: SNF psychiatric conditions," Long-Term Living Magazine (January 2, 2014)
• “Will Your Documents Withstand Scrutiny?,” PADONA Journal (January-April 2013)
• “Clarifying The Impact Of DPW’s ‘Provider Preventable Conditions’ Bulletin On Nursing Homes,” PADONA Journal (September-December 2012)
• “New Focus on Emergency Preparedness,” PADONA Journal (May-August 2012)
• “Prepare for Impact of ‘Never Events’ on Post-Acute Care,” Long Term Living (February 2012)
• “New DPW Requirement to Check Exclusion Lists Monthly,” PMDA (Fall 2011)
• “CMS Clarifies Special Focus Facility Scoring Methodology,” PADONA Journal (October-December 2008), and American Society for Long Term Care Nurses Journal (Winter 2008)
• “State Board of Nursing Issues Proposed Regulations for CRNPs,” PADONA Journal (October-December 2008), and American Society for Long Term Care Nurses Journal (Winter 2008)
• “Pennsylvania Medicaid Implements New Tort Recovery Policies and Procedures,” PADONA Journal (October-December 2008), and American Society for Long Term Care Nurses Journal (Winter 2008)
• “The Survey Clock is Ticking: Life Safety Code Violations May Extend Compliance Periods, PADONA Journal (July-September 2008)
• “Strengthening Internal Control: Considerations for Board and Management, New Perspectives (May 2008)
• “Are Registered Sex Offenders in Your Midst?” Contemporary Long-Term Care (July/August 2007) (Co-authored with Barbara Zemlock)

• Through the Looking Glass:  A Journey Through Post-Acute Regulation and Enforcement, PBI Health Law Institute 2024 (March 13, 2024)
• Challenges With Guardianship and Decision Making, PMDA Conference, Gettysburg, PA (October 6, 2023)
• Regulatory Update, FSA Compliance Conference, Fraser, PA (October 4, 2023)
• Unpacking the New DOH Regulations, 2023 PACAH Fall Summit, Harrisburg, PA (September 26, 2023)
• Preparing for New Regulations for Long-Term Care Facilities, Quality Insights Webinar (June 13, 2023)
• Understanding The Survey Enforcement Cycle And Options, LeadingAge PA Webinar (April 20, 2023)
• A Deep Dive into New PA DOH Change of Ownership Requirements, Pennsylvania Health Care Association (PHCA) webinar (April 19, 2023)
• A Deep Dive into the New DOH Regulations - Part 1, Pennsylvania Health Care Association (PHCA) webinar (February 23, 2023)
• Identifying and Mitigating Cybersecurity Threats, Pennsylvania Coalition of Affiliated Healthcare & Living Communities (PACAH) 2022 Spring Conference (April 19, 2022)
• Survey Preparedness: F880 and Beyond, Pennsylvania Health Care Association (PHCA) webinar (February 9, 2022)
• Vaccine Mandate Questions Answered, PADONA webinar (February 8, 2022)
• CMS Vax Mandate Unlikely to Go Away - What We know Now, PADONA webinar (November 17, 2021)
• Looking Beyond the Immediate COVID-19 Crisis: What You Can Be Doing Now, Pennsylvania Health Care Association's (PHCA) 2020 Virtual Convention & Trade Show (November 10, 2020)
• Challenges and Solutions for your Regulatory Pressure Points, Pennsylvania Coalition of Affiliated Healthcare & Living Communities (PACAH) Virtual 2020 Fall Conference (September 30, 2020)
• The New Normal? Changes in Surveys and Enforcement, PHCA Webinar (August 25, 2020)
• Allegations of Abuse and Neglect: Understanding Regulatory, Reputational, and Criminal Exposures, 2020 Virtual LeadingAge PA Annual Conference and Expo (August 19, 2020)
• CMS Mandates On-Site Focused Infection Control Surveys: Implications and Strategies, PHCA Webinar (June 5, 2020)
• Truth or Fiction: COVID-19 Reporting in Pennsylvania, PHCA Webinar (June 5, 2020)
• Nursing Facility Compliance & Survey Update, LeadingAge PA Webinar (January 29, 2020) 
• Legal Perspective: Survey Risks and Proactive Strategies, Clinical Consulting Services, 4th Annual Clinical Excellence Summit, Harrisburg, PA (December 11, 2019) 
• Oversight Without Overstepping: New ROPs Obligations for Governing Bodies, co-presented with K. Dreisbach and J. Mack, LeadingAge Annual Meeting & Expo, San Diego, CA (October 28, 2019) 
• Engaging Boards in Compliance and Quality: Oversight and Responsibility Workshop, FSA Compliance & Risk Management, King of Prussia, PA (September 25, 2019)
• Keynote Speaker, Regulatory Update, FSA Compliance and Risk Management Conference, King of Prussia, PA (September 25, 2019)
• Proving Corrected Past Noncompliance to Reduce Risk, Pennsylvania Health Care Association (PHCA) 2019 Annual Convention and Trade Show, King of Prussia, PA (September 24, 2019)
• Managing Long-Term Care Survey Data and Adverse Events, AHIMA Health Data and Information Conference, Chicago, IL (September 17, 2019)
• Are You Ready for Phase 3 of the ROPs? PADONA's 31st Annual Convention, Hershey, PA (April 3 - 5, 2019)