Clio Work for Healthcare and Medical Regulatory Law
Pick a task, copy the prompt, and run it on your matter in Clio Work.
Prompts
Legal Research
Find Stark Law exceptions for a group practice
Transactional
Which Stark Law exceptions apply to physician group practice arrangements, including the in-office ancillary services, employment, and fair market value compensation exceptions? For each, explain the required elements, documentation, and common compliance pitfalls, and cite the controlling regulations and CMS guidance.
Find AKS safe harbors for physician advisor deals
Transactional
Which Anti-Kickback Statute safe harbors apply to arrangements where a medical device manufacturer pays physicians as advisors, including the personal services safe harbor and the 2021 value-based arrangement safe harbors? Explain each requirement and the risk factors OIG considers, and cite the controlling regulations and guidance.
Confirm the required terms in a business associate agreement
Transactional
What provisions must a HIPAA Business Associate Agreement include under 45 C.F.R. 164.504(e), and how did the Omnibus Rule expand business associates' direct liability? Include subcontractor requirements and breach notification duties, and cite the controlling regulations.
Check the requirements for an FCA qui tam case
Litigation
What are the requirements for a False Claims Act qui tam case, including the first-to-file bar, public disclosure bar, the Escobar materiality standard, and how a government declination affects the relator's recovery? Cite the controlling statute and leading cases.
See how courts define AKS intent
Litigation
How have courts defined the intent standard under the Anti-Kickback Statute, and how does an AKS violation create False Claims Act liability for healthcare providers and suppliers? Explain the causation standard courts apply and cite the leading cases.
Check the standard for a healthcare injunction
Litigation
What standard governs preliminary injunctive relief in healthcare certificate of need challenges or provider exclusion proceedings? Explain each factor, how courts apply it in these cases, and any exhaustion or jurisdiction issues, and cite the leading cases.
Document Analysis
Check a physician employment agreement for Stark compliance
Transactional
Review this physician employment agreement for compliance with the Stark Law compensation exceptions, fair market value documentation, and productivity-based compensation triggers. Provide a table with the provision, issue, compliance risk, and recommended revision, and flag anything that needs attorney review.
Pull coverage rules from managed care policies
Transactional
From these managed care payor contracts, extract the covered services, patient eligibility criteria, prior authorization requirements, and exclusions. Provide a table with one row per contract and section references for each item.
Pull rates and terms from payor contracts
Transactional
From these managed care agreements, extract the reimbursement rates, covered services, prior authorization requirements, termination notice periods, and audit rights. Provide a table with section references and flag any unfavorable or unclear terms.
Break down the allegations in an FCA complaint
Litigation
From this False Claims Act complaint or civil investigative demand, extract the alleged Stark Law or Anti-Kickback violations, referral patterns, financial arrangements, and damages theory. Provide the results as a table with paragraph references.
Summarize findings from CMS or OIG proceedings
Litigation
Review these CMS administrative hearing or OIG exclusion proceeding transcripts and identify the agency's findings, contested compliance issues, and arguments preserved for judicial review. Provide a table with the issue, each side's position, the finding, and the page and line reference.
Summarize each qui tam complaint
Litigation
From each qui tam complaint or government investigation notice, extract the type of false claim, billing codes, estimated damages, statutory basis, and relator identity. Provide the results as a table with one row per document and source references.
Skills
Skills save the way your firm does a task, so anyone at your firm gets the same result.
Get consistent, high-quality work from everyone at your firm, every time. A skill saves a task you repeat in your firm’s format and standards, so anyone on your team can run it. Use skills for document analyses, client letters, and strategy recommendations.
Organize claims for No Surprises Act dispute resolution
Organizes claims data and records into the structure the No Surprises Act dispute resolution process requires.
Create This Skill
Create a skill that reads the claims data and records in this matter and organizes them into the format required for a No Surprises Act independent dispute resolution submission. It should note any state-specific requirements and list any missing information.
Calendar statutory deadlines from a claim file
Finds the hard statutory deadlines in a claim file and adds them to the calendar after approval.
Create This Skill
Create a skill that reads the claim file in this matter, identifies every hard statutory deadline, and shows me the list with sources. After I approve them, it should add the dates to the firm calendar in Clio Manage.
Draft a medical monitor agreement from your own
Drafts new medical monitor agreements for US clinical trials from the firm's existing agreement.
Create This Skill
Create a skill that drafts a new medical monitor agreement for a US clinical trial, using my uploaded agreement as the template and the deal terms in this matter. It should list any terms it couldn't find so I can fill them in.
Draft Templates
Draft documents from a prompt, or fill your firm’s own templates with details from the matter.
Get from a blank page to a first draft in minutes. Describe the document, and Clio Work drafts it from your matter’s facts and your jurisdiction’s law. Or turn your firm’s own documents into templates that fill in party names, dates, and terms from the matter.
Draft from a prompt
Draft an AKS physician compensation policy
Transactional
Draft a hospital system compliance policy on Anti-Kickback Statute requirements for physician compensation. Cover fair market value documentation, annual attestations, and review and approval procedures, and include roles, escalation steps, and recordkeeping requirements.
Draft a motion to dismiss a Stark-based qui tam complaint
Litigation
Draft a motion to dismiss a False Claims Act qui tam complaint alleging Stark Law violations. Argue that the complaint fails to plead fraud with particularity under Rule 9(b) because it doesn't identify specific claims, dates, or amounts, and cite the controlling pleading standard cases.
Build your firm templates
Business Associate Agreement
Fills the firm's HIPAA business associate agreement for each vendor. Upload your firm's version, and Clio Work turns the covered entity, business associate, effective date, and services into fields it fills from each matter. Then review the suggested rule that adds the subcontractor section only when the business associate uses subcontractors.
Physician Employment Agreement
Starts each physician contract from the firm's standard form. Upload your firm's version, and Clio Work turns the physician, employer, specialty, base salary, and term into fields it fills from each matter. Then review the suggested rule that adds the productivity bonus section only when compensation includes a wRVU bonus.
Overpayment Refund Letter
Reports and returns an identified overpayment to a payor. Upload your firm's version, and Clio Work turns the provider, payor, NPI, claim numbers, overpayment amount, and identification date into fields it fills from each matter. Then review the suggested rule that adds the sampling methodology paragraph only when the amount was calculated by statistical sampling.
Visualizations
Visualizations make charts, calendars, and diagrams from your matter data.
Build the exact view you need, right when you need it. Describe it in plain language, and Clio Work builds an interactive tool from your matter data, such as a case chronology or a settlement calculator. Download it and share it with clients and colleagues.
Map referral and compensation relationships
Shows the financial relationships between physicians and referral sources.
Create This Visualization
Using visualizations, create an interactive diagram of each physician, entity, and referral relationship, showing the compensation paid and the Stark or Anti-Kickback exception relied on. Use the agreements and compensation records in this matter.
Chart the results of a claims audit
Charts billing errors and overpayments found in a claims audit.
Create This Visualization
Using visualizations, create an interactive chart of audit findings by billing code, error type, and dollar amount, with the estimated overpayment and repayment deadline. Use the claims audit data in this matter.
Lay out an investigation timeline
Lays out the key events in an investigation or qui tam case.
Create This Visualization
Using visualizations, create an interactive timeline of key events, document productions, and deadlines, with the source document noted for each event and upcoming deadlines highlighted. Use the subpoenas, civil investigative demands, and filings in this matter.
Track license and credential renewals
Shows license, credential, and enrollment renewal dates for every provider.
Create This Visualization
Using visualizations, create an interactive dashboard of each provider's licenses, payor enrollments, and renewal dates, and flag anything expiring in the next 90 days. Use the licensing and credentialing records in this matter.
Track No Surprises Act dispute claims
Shows the status and outcomes of No Surprises Act dispute claims.
Create This Visualization
Using visualizations, create an interactive dashboard of IDR disputes by payor, status, amount in dispute, and outcome, with a chart of win rates by payor. Let me filter by date range and payor. Use the claims and determinations in this matter.