Mary Grace Griffin represents clients across the health care industry, guiding them through complex regulatory, compliance, and enforcement matters. Her regulatory and transactional practice spans federal and state issues involving the Anti-Kickback Statute, Stark Law, Civil Monetary Penalties Law, False Claims Act, Medicare and Medicaid reimbursement, the No Surprises Act, state balance billing restrictions, the 340B drug pricing program, and a wide range of licensing, enrollment, and transaction-related requirements.
A significant portion of Mary Grace's counseling centers on health care fraud and abuse concerns. She advises clients on compliance with the Anti-Kickback Statute, Stark Law, Civil Monetary Penalties Law, and False Claims Act, and regularly assists in identifying, analyzing, and disclosing overpayments to the Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, and managed care organizations through available self-disclosure protocols. Drawing on extensive regulatory and enforcement experience, she helps clients anticipate and mitigate risk, respond effectively to government investigations, and structure compliant business arrangements.
Mary Grace also advises on reimbursement and payment matters, including Medicare and Medicaid coverage and billing, managed care contracting and disputes, and value-based reimbursement methodologies. She partners with hospitals, physician groups, laboratories, and other providers to address overpayment demands, manage reimbursement audits and appeals, and adapt to evolving payer requirements.
She has substantial experience counseling clients on compliance with the No Surprises Act, hospital price transparency requirements, and state balance billing laws. She works with providers and facilities to implement policies, procedures, and agreements that promote compliance, reduce financial and legal risk, and protect patients in accordance with changing statutory and regulatory frameworks.
In addition, Mary Grace assists covered entities and contract pharmacies with all aspects of the 340B drug pricing program, including eligibility, recertification, audit preparation, and corrective action measures. She provides practical strategies to help clients maximize program value while ensuring regulatory compliance under Health Resources and Services Administration (HRSA) oversight.
Her practice also encompasses provider enrollment and state licensure matters. Mary Grace represents clients during CMS, Joint Commission, Emergency Medical Treatment and Labor Act (EMTALA), and state surveys – helping them respond to citations, develop corrective action plans, and appeal adverse findings.
Mary Grace advises health care providers on a wide range of corporate and transactional issues, including structuring physician arrangements in compliance with corporate practice of medicine restrictions and obtaining necessary state and federal approvals for mergers, acquisitions, and other complex integrations, such as attorney general review of hospital transactions.