Colin P. McCarthy
Biography
Colin is a healthcare regulatory attorney who guides providers through complex compliance and regulatory challenges. Diverse healthcare organizations—from hospitals and health systems to behavioral health providers and medical equipment suppliers—seek out Colin’s counsel to navigate critical compliance matters prevalent in one of the country’s most regulated industries.
His regulatory practice focuses on billing and coding, overpayment disputes, government audits, HIPAA compliance, False Claims Act issues, Stark/Anti-Kickback compliance, and day-to-day operational issues. Working extensively with state agencies, CMS, state Medicaid agencies, and accreditation bodies, Colin helps clients maintain compliance with licensure, enrollment, and certification requirements while minimizing operational disruptions.
Colin also plays a vital role in healthcare transactions, including structuring transactions to comply with corporate practice of medicine laws, conducting regulatory due diligence, and developing risk mitigation strategies such as voluntary refunds and OIG self-disclosures.
A recognized thought leader in healthcare law, Colin regularly publishes and presents on emerging compliance issues. He serves his community through pro bono work with the Legal Information Network for Cancer and the VCU Medical Legal Partnership. Super Lawyers named him a “Virginia Rising Star” in healthcare law from 2018-2020.
Practices
Representative Matters
- Represented academic medical center in ALJ hearing before the Office of Medicare Hearings and Appeals (OMHA) in a significant overpayment dispute
- Represented an academic medical center in Medicaid appeal regarding high-dollar claim denial
- Represented hospital in successful appeal of CMS’ termination of sole community hospital status
- Represented hospital in successful appeal of CMS’ termination of Critical Access Hospital status
- Represented multiple physician practices in OIG self-disclosures and settlements regarding incident-to billing
- Represented health system in OIG self-disclosure and settlement regarding excluded individual
- Represented physician practices in CMS Self-Referral Disclosure Protocol submissions
- Represented of healthcare providers in requesting advisory opinions from the OIG
- Represented national ASC management company in regulatory filings and approvals for acquisitions of multiple ASCs
- Led the regulatory filings and approvals process for a health system in acquisition of two hospitals
- Led the regulatory filings and approvals process for multiple acquisitions of physician practices, pharmacies, DME suppliers, and physical therapy practices
- Represented dozens of healthcare providers in administrative appeals of Medicare, Medicaid, and commercial payer audits
Recognition & Honors
- Virginia Rising Stars, Virginia Super Lawyers, 2018-2020
- Pro Bono Honor Roll; Virginia State Bar, 2023
Associations
- American Health Law Association; Vice Chair, Accreditation, Certification, and Enrollment Affinity Group, 2016-present
- Legal Information Network for Cancer Pro Bono Attorney, 2015-present
- Virginia Bar Association; Health Law Section
- Virginia State Bar; Health Care Section
- Health Care Compliance Association
- Healthcare Financial Management Association
Seminar & Presentations
- Speaker, HIPAA and Healthcare Transactions, November 2, 2022
- Moderator, “Behavioral Health & Substance Abuse Treatment,” 15th Annual Healthcare Finance and Growth Conference, September 15, 2022
- Speaker, “2019 Medicare and Medicaid Year In Review,” AHLA Institute on Medicare and Medicaid Payment Issues, March 25, 2020
- Speaker, “Government Enforcement Actions Against Providers,” Healthcare Litigation and Compliance Webinar Series, July 19, 2018
- Speaker, “Best Practices for Responding to Medicare Claims Audits and OIG Compliance Audits,” Healthcare Litigation and Compliance Webinar Series, March 22, 2018
- Speaker, “Year in Review,” Institute on Medicare and Medicaid Payment Issues, March 2017
- Co-presenter, “Provider-Based Status: Recognizing Evolving Compliance Risks and Remembering the Fundamentals,” American Health Lawyers Association Fraud & Compliance Forum, October 2016
- Co-presenter, “Developing and Implementing Hospital Capital Projects,” Virginia Hospital & Healthcare Association, March 2016
- Co-presenter, “Structuring Healthcare Co-Location Arrangements,” Strafford Webinar, June 2015
- Presenter, “Healthcare Regulation,” Virginia Commonwealth University eMBA Program, June 2015
- Moderator, “Hospital Co-Location,” American Health Lawyers Association Webinar, May 2015
- Co-presenter, “Inpatient or Observation? Practical Advice for Hospitals on Compliance with CMS’ ‘Two Midnight’ Benchmark,” Healthcare Financial Management Association VA/DC Spring Education Conference, March 2014
- Co-presenter, “Payer Audit, Enforcement & Compliance: Are You a Target,” Medical Group Management Association Virginia Chapter, December 2013
- Co-presenter, “A New Era of Government Enforcement: Strategies for Preparing for and Responding to Government Audits,” Health Care Compliance Association Clinical Practice Compliance Conference, October 2013
- Co-presenter, “Avoiding Costly Medicare Enrollment Errors,” Healthcare Financial Management Association VA/DC Summer Conference, August 2011
Education
- Christopher Newport University; B.A., 2007
- William & Mary Law School; J.D., 2010