Douglas A. Grimm, FACHE
Douglas Grimm is a health care regulatory lawyer who previously served as a former Chief Operating Officer of multiple acute-care hospitals throughout the United States. He remains active in health care administration as a Fellow of the American College of Healthcare Executives (FACHE), the premier certification institution in health care management. This unique background enables Douglas to provide legal counsel with a practical, pragmatic perspective gained from a decade of experience as a health care executive.
Douglas focuses his practice on the representation of hospitals and health care systems with an emphasis on regulatory counseling in the areas of compliance planning, government investigations, health information privacy and security, reimbursement issues, health information technology, peer review/medical staff and certificates of need, development of new service lines, licensure and provider enrollment, and insurance issues.
In addition to health care systems, Douglas’ clients also include specialty providers, physician group practices, ambulatory surgical centers, skilled nursing facilities, diagnostic imaging centers, health maintenance organizations, and home health agencies.
He regularly represents clients before the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) in the defense of Stark Law, anti-kickback statute, and False Claims Act (FCA) proceedings, as well as handles self-disclosure processes as appropriate. He also represents clients before the Office for Civil Rights regarding issues arising from the Health Insurance Portability and Accountability Act (HIPAA).
Douglas’ client engagements include:
- Represented an integrated health system in a qui tam case involving parallel Stark and anti-kickback investigations by CMS and OIG of medical necessity issues; handled self-disclosure and other communications with federal and state authorities.
- Represented a specialty surgical hospital before the Department of Justice in a proceeding charging a hospital contractor with criminal fraud and money laundering, with no adverse consequence to the hospital.
- Represented a community health system before the Office for Civil Rights in a HIPAA breach proceeding involving the electronic health records of over 100,000 individuals with no adverse consequences to the health system.
- Advised a large academic medical center on the development and implementation of compliance plans and related procedures based on CMS and OIG regulations, federal law, applicable state statutes and regulations, and The Joint Commission requirements.
- Represented an investor-owned chain of nursing homes in its sale to a nonprofit community health system.
- Represented physicians and physician groups in various recovery audit contractor proceedings involving claims in excess of $3 million.
- Advised a community health system regarding a $180 million acquisition of multiple Ambulatory Surgery Centers (ASCs).
In addition to his FACHE certification, Douglas is also a member of the American Health Lawyers Association (AHLA); Health Care Compliance Association; District of Columbia Bar Association, Health Law Section; Pennsylvania Bar Association, Health Law Section; and Texas Bar Association, Health Law Section.
Publications, Presentations, & Recognitions
Douglas is a frequent author and lecturer on current issues facing health care providers and payors, including trends in fraud and abuse enforcement, HIPAA compliance, and health information technology.
Recent speaking engagements include:
- Panelist, “Access to Care: The Patient Legal Advocate’s Perspective,” National Proton Conference, January 20, 2016
- Panelist, “Managing Employed Physician Exposures within the Hospital Insurance Program - Risk or Reward?” Crittenden Medical Insurance Conference
- Speaker, “Unique Partnerships – Structure,” Pennsylvania Institute of Certified Public Accountants
- Presenter, “The Affordable Care Act: It’s Here – Now What?” Southern New Jersey Chamber of Commerce
- Speaker, “C-Suite Roundtable at George Washington University Marvin Center,” National Capital Healthcare Executives
- Speaker, “Hard to Say ‘I’m Sorry’: Teaching Disclosure to Front-Line Doctors and Nurses,” American Society for Healthcare Risk Management
- Presenter, “The Impact of the Affordable Health Care Act on Hospitals,” Investment Management Institute
- Speaker, “Health Care Social Media,” National Renal Administrators Association
- Presenter, “Health Care Reform: A Prescription for Change,” Southern New Jersey Chamber of Commerce
- Speaker, “The OIG and You: Health Care Compliance,” National Capital Healthcare Executives
- Presenter, “The 2011 OIG Work Plan, What You Need to Know,” National Webinar
Recent articles include:
- “Increased Healthcare M&A Activity: Representation and Warranty Insurance Coverage,” The Ambulatory M&A Advisor, December 2014
- “Surviving an Audit by the Food and Drug Administration,” Torus Insurance Healthcare Insight, November 2013
- “Impact of Health Care Laws on M&A Transactions,” The Legal Intelligencer, March 2013 (Vol. 247 No. 53)
- “The Nation Has Spoken on Health Care. The Question Now Is Where Do We Go Next,” Impact Times, December 2012 (Vol. III No. 4)
- “Wither Or Whither Healthcare Reform?” Metropolitan Corporate Counsel, August 2012
- “Major Changes to HIPAA Privacy, Security, and Enforcement Rules Proposed by HITECH Privacy NPRM,” BNA Health IT Law & Industry Report, 2 HITR 32, August 2010
- “The Practice Guide to Release of Information,” HCPro Inc., 135-64
- “Informed Consent for All! No Exceptions,” 37 New Mexico Law Rev. 39 (Winter 2007)
- “Medicare Enrollment Appeals,” Dennis Barry’s Reimbursement Advisor, May 2007 (Vol. 22, No. 9)
- “OIG Continues to Scrutinize Place of Service Coding,” Dennis Barry’s Reimbursement Advisor, March 2007 (Vol. 22, No. 7)
- “FDA, CLIA, or a ‘Reasonable Combination of Both’: Toward Increased Regulatory Oversight of Genetic Testing,” 41 San Francisco Law Rev. 107 (Fall 2006)
- “CMS Issues Final Rule and Revised Forms for Medicare Enrollment,” Dennis Barry’s Reimbursement Advisor, November 2006 (Vol. 21, No. 11)
- “HHS’s Semi-Annual Regulatory Agenda,” Dennis Barry’s Reimbursement Advisor, (Vol. 21, No. 5)