Based in Pittsburgh, PA, Adam J. Falcone is a partner in FTLF’s national health care practice group, where he counsels a diverse spectrum of community-based organizations that render primary and behavioral healthcare services. He counsels clients on a wide range of health care issues, with a focus on fraud and abuse, reimbursement and payment, and antitrust and competition matters.
Mr. Falcone established the firm’s health care corporate compliance practice, offering proactive counsel to avoid costly legal missteps that can jeopardize vital health services within communities. To that end, he has championed the development of online compliance support services to assist clients in the development of effective corporate compliance programs. He also conducts internal investigations, defends clients in audit proceedings, and negotiates settlements related to fraud allegations.
Drawing on his extensive knowledge of health care policy and markets, Mr. Falcone regularly speaks to groups across the country on managed care contracting and value-based payment methodologies. In particular, he brings strategic counsel to clients that are responding to changes in their local marketplace, negotiating participating provider agreements, and seeking to establish provider networks such as Accountable Care Organizations.
Prior to joining the law firm, Mr. Falcone served as Program and Policy Counsel at the Alliance of Community Health Plans, a national association of non-profit and provider-owned health plans advocating federal policies to improve health care quality. Working at the intersection of law and policy, he represented the Alliance before the Congress and Executive Branch.
Mr. Falcone began his legal career in Washington, D.C. as a trial attorney in the Antitrust Division of the U.S. Department of Justice. As a member of the Health Care Task Force, he led and participated in civil antitrust investigations and litigation of anticompetitive activity among health care providers.
Mr. Falcone understands how the law can both promote and impede his clients’ missions. He seeks to provide innovative legal solutions that minimize his clients’ legal risks while preserving their resources to serve their communities.
- Assisting health care providers in forming provider networks to implement accountable care models without running afoul of antitrust laws.
- Educating health and human service organizations on current fraud and abuse enforcement activities, key risk areas, and the elements of effective compliance programs.
- Conducting trainings on strategies for negotiating successful managed care contracts, the meaning of standard contract terms, and addressing problematic provisions.
- “Compliance is Everyone’s Job,” National Council for Behavioral Health, NatCon Conference. 2016.
- “Managed Care Contracting: Negotiating from a Position of Strength,” National Council for Behavioral Health, NatCon Conference. 2016.
- “Compliance and the Board of Directors,” National Council for Behavioral Health, NatCon Conference. 2016.
- “Attaining Clinical and Financial Integration in an Accountable Care World,” National Association of Community Health Centers, Policy and Issues Forum. 2016.
- “Accountable Care Readiness: Peer to Peer Networking Session,” National Association of Community Health Centers, Policy and Issues Forum. 2016.
- “The Medicaid Certified Community Behavioral Health Clinic (CCBHC) Demonstration: New Opportunities, New Challenges”, Minnesota Association of Community Mental Health Programs. 2016.
- “The Medicaid Certified Community Behavioral Health Clinic (CCBHC) Demonstration: New Opportunities, New Challenges”, Illinois Association of Rehabilitation Facilities. 2016.
- Graduate Certificate in Healthcare Corporate Compliance, George Washington University School of Public Health and Health Services and College of Professional Studies, 2005 – Present
- Corporate Compliance Training Program, Nat’l Association of Community Health Centers, 2007-Present
- Alliance of Community Health Plans, Program and Policy Counsel (2002-2004)
- U.S. Department of Justice, Antitrust Division, Trial Attorney (2001-2002)