Tom Herrmann, JD
Managing Senior ConsultantCorporate Headquarters
5911 Kingstowne Village Parkway
Alexandria, VA 22315
Tom Herrmann addresses compliance and regulatory/legal issues for a number of health care companies, providers and professionals. This includes the development, implementation, assessment, and management of compliance programs. His clients include device manufacturers, managed care organizations, health care systems, hospitals, nursing homes, DME suppliers, and individual health care professionals. In light of his extensive past professional experience, he is a recognized expert on issues related to the federal Anti-Kickback Statute and Stark Law. Accordingly, he is frequently called upon to assist clients in evaluating physician arrangements and other situations that may implicate those laws. Mr. Herrmann also assists clients in meeting the compliance requirements of Corporate Integrity Agreements (CIAs), and acting as an Independent Review Organization (IRO) for health care entities and practitioners that have entered into a CIA with the Office of Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS). He is often retained to assess compliance in high risk areas with applicable legal and regulatory requirements. He also conducts legal and regulatory “due diligence” compliance reviews for health care entities contemplating new business relationships. He undertakes independent verification reviews for potential “self disclosures” to governmental authorities, and is involved in counseling clients on risk assessment and remediation strategies. He is also retained to serve as an expert in False Claims Act litigation and to provide an assessment of the applicability of legal requirements to specific factual situations. In addition, as a former Administrative Appeals Judge on the HHS Medicare Appeals Council, he advises and assists clients with Medicare claims appeals and OIG administrative sanctions issues.
Mr. Herrmann participates and frequently presents at health care compliance and legal forums on significant issues in the health care enforcement and regulatory arena. He has authored articles for professional journals on various issues, such as the responsibilities of IROs, the OIG’s adoption of the “Responsible Corporate Officer” doctrine, and the Medicare claims appeals process.
Previous Work Experience
Mr. Herrmann has over 30 years of legal experience with the U.S. Department of Health and Human Services (HHS). Most recently, he served a six year term as an Administrative Appeals Judge (AAJ) on the Medicare Appeals Council, the final level of HHS administrative review. In that capacity, he adjudicated health care provider, supplier, and beneficiary cases involving eligibility, coverage, and payment for health care services furnished to Medicare beneficiaries.
For the prior 20 years, Mr. Herrmann held various positions in the HHS Office of Inspector General (OIG). He acted as the Director of the OIG’s Office of External Affairs, and supervised OIG policy professionals; developed and responded to legislative proposals relating to fraud, waste, and abuse in HHS programs; drafted testimony for the OIG; and developed regulations and policy guidance implementing OIG administrative sanction authorities. He also chaired an HHS Task Force on Managed Care issues to facilitate communications and activities between the Centers for Medicare & Medicaid Services (CMS) and OIG. His OIG responsibilities included reviewing requests filed by excluded health care providers seeking reinstatement to federal health care programs, and serving on the Federal Interagency Suspension and Debarment Coordinating Committee.
Mr. Herrmann served for a number of years in the OIG Counsel’s Office as Chief of the Administrative Litigation Branch, and supervised the litigation of cases involving the imposition of civil monetary penalties and program exclusions. He managed the litigation of administrative sanction cases, as well as coordinated negotiation and settlement of cases with the U.S. Department of Justice (DOJ) and CMS. His responsibilities included the development of Corporate Integrity Agreements (CIAs), and approval of Independent Review Organizations (IROs). Mr. Herrmann was also engaged in the development and implementation of the OIG’s civil money penalty and exclusion authorities, including the promulgation of regulations, issuance of program guidance, and negotiation and litigation of cases. He regularly supported OIG audits and investigations through the issuance of subpoenas and provision of legal advice to auditors and investigators.