Our Health Law attorneys have extensive experience with health care fraud and abuse law and health regulatory issues. We represent diverse sectors of the health industry, including hospitals, outpatient facilities, IPAs, physicians, ACOs, dentists, nursing homes, assisted living facilities, home health agencies, pharmaceutical companies, medical suppliers and pharmacists. Our practice covers the following core health law areas:
Health Law Regulations
- Facility licensure and regulation
- Certificates of Public Advantage (COPA) and regulatory waivers to accommodate value based contracting programs
- Medical records and regulation of protected health information (HIPAA)
- Medical staff credentialing and privileges
- Managed care contracting, including value based contracting and other DSRIP programs
- Antitrust law and restrictive covenants
- Professional malpractice and misconduct, medical consent
Fraud and Abuse
- Anti-kickback statutes and safe harbors, and fee splitting laws
- The Stark Law and state self-referral laws
- Corporate practice of medicine and scope of practice issues
- Medicare and Medicaid reimbursement rules
- False Claims Act, including “whistle blower” cases
- Corporate compliance programs and white collar criminal defense
Attorneys in our Health Law Practice Group have strong commercial, business and tax law backgrounds as well as years of practical legal and management experience in the health care industry. As a result, we offer a unique expertise in the following areas:
- Corporate structuring, formation and governance, payment program structuring and asset protection
- Tax counseling, including for tax exempt organizations
- Stockholder, LLC, partnership, and employment agreements
- Buy-sell agreements for equity and asset deals
- Hospital-physician contracts and joint ventures
- Medical service and supplier contracts, and financing agreements
- Medical office leasing and other real estate transactions
- Not-for-profit corporation law
Representative Health Law Matters
Outside Health Law Counsel
- Served as corporate compliance counsel and outside corporate counsel to multispecialty practice with 280 physicians practicing at over 30 offices in New York, New Jersey and Connecticut.
- Served as outside regulatory and compliance counsel to a large IPA participating in New York State’s Medicaid VBP Innovator Program.
- Acted as health law and corporate counsel to companies that provide medical billing and revenue cycle management services.
- Served as health law and outside corporate counsel to diagnostic and treatment (D&T) centers on reimbursement, physician compensation and contracting, and corporate compliance matters.
- Served as outside counsel to ambulatory surgery centers.
- Acted as corporate and healthcare counsel for multiple hospitals on technology agreements and other intellectual property matters.
- Represented IPAs and medical practices on regulatory issues, including antitrust and fraud and abuse laws, and corporate restructuring in connection with their transition to new care delivery models, including VBP under the Delivery System Reform Incentive Payment (DSRIP) program and Medicaid/Medicare managed care arrangements.
- Represented Ambulatory Surgical Center in sale of its assets for $14 million.
- Represented hospitals in negotiations with equipment manufacturers for state-of-the-art medical equipment, including surgical robots and radiology equipment.
- Represented ophthalmology practice, including optometry practice, in sale of its assets to hospital system for $1 million.
- Represented home health agency in sale of its assets for $925,000.
- Represented buyers of radiology centers for $2.8 million and $1.85 million.
- Represented medical practices and hospitals in negotiations with vendors for billing and collection software and services.
- Advised medical practice in the establishment of infusion center with hospital.
- Represented technology vendor in drafting and negotiating $3 million service agreement with a PPS in the DSRIP program.
- Advised radiology practice on joint venture with hospital to establish an imaging center.
- Represented multi-office physical therapy practice in sale of assets for $12.7 million.
Health Information Technology
- Represented hospital system in negotiations with an EHR vendor for a $12 million roll-out and implementation of an EHR system to its hospitals and ambulatory centers.
- Advised medical groups concerning HIPAA compliance audits and implementation of security rule.
- Represented hospital in negotiation with IT vendor for a $60 million agreement for billing software and outsourcing IT management services.
Fraud and Abuse
- Defended multiple healthcare providers in actions and investigations of alleged violations of billing requirements, overpayment demands, HIPAA and healthcare fraud and abuse laws.
- Represented numerous physician groups, ASCs, hospitals and D&T centers on issues arising under Stark Law, anti-kickback statute, false claims act and other healthcare fraud and abuse laws, including how to structure arrangements to comply with such laws and requesting Office of Inspector General (OIG) Advisory Opinions.
- Prepared OIG Advisory Opinion requests for proposed business arrangements under federal anti-kickback statute and other OIG sanction statutes.
- Represented physical therapy group in successful recovery of $480,000 from commercial payors for improper out-of-network payments.
- Advised various healthcare providers on self-disclosure processes and prepared submissions under the OIG’s and the Office of Medicaid Inspector General’s (OMIG)’s Provider Self-Disclosure Protocol to report potential fraud.
- Represented medical practices and hospitals in CMS meaningful use audits.
- Represented pharmaceutical companies in government investigations and False Claims Act litigation relating to government price reporting and Medicaid reimbursement issues.
Health Law Regulatory
- Represented Performing Provider System (PPS) under New York’s Delivery System Reform Incentive Payment (DSRIP) program comprised of over 4,000 medical providers.
- Advised large multistate pathology laboratory in establishment and growth of technical component/professional component (TC/PC) arrangements between pathologists and physician groups.
- Represented and advised management companies in providing administrative services, equipment and property to medical practices.
- Represented company in its establishment and sale of a dental implant imaging business that contracted with dental and imaging centers throughout New York City metropolitan area.
- Counseled providers in appropriate reporting of data breaches to the Office of Civil Rights (OCR), state authorities and affected patients and conducted internal investigations and HIPAA Security Audits.
- Represented large psychiatric medical practice in structuring professional service arrangements with associated psychologists and other therapy providers.
- Counseled hospital and physician groups on development of clinically integrated network for joint payor contracting in compliance with antitrust laws.
- Drafted HIPAA security and privacy policies for covered entities and business associates.
Bleakley Platt is committed to our clients’ success and believes that in some instances, an alternative fee arrangement may be preferable to a traditional hourly fee structure. Such arrangements require approval by the Firm’s management. To learn more about the Firm’s policy regarding alternative fee arrangements, click here or speak with a partner.