Attorneys in the Healthcare Group Include: Litigation Paralegals include: Elise Thurman
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Our Healthcare Group provides a broad scope of services to healthcare providers. Our lawyers combine experience in health law issues with involvement in the healthcare industry. We bring an interdisciplinary approach to our client’s matters assigning the team with the best combination of skills and experience to achieve the desired result. We also plan for the most efficient use of resources to deliver excellent service cost effectively.
Medi-Cal and Other State Payer Reimbursement
Compliance, Fraud & Abuse,
False Claims ActPROVIDER-PAYER LITIGATION. We exclusively represent providers in their contract disputes with payers. We have collected millions of dollars for hospitals and other providers throughout California in contract litigation against most of the major payers. Representative of the issues we have addressed are: percent-of-premium capitation rate reductions, transplant pool payments, adverse selection issues, reduction or disallowance of charge master rates, application of trauma rates, downcoding, stop loss rate and threshold disputes, level of care and medical necessity disputes, audit disputes concerning line item charges, “late” charges, and scope of audits, and administrative claims against Medi-Cal GMC, COHS, and Two-Plan Model plans for payment for emergency services.
MEDICARE REIMBURSEMENT. Our attorneys have won millions of dollars for provider clients in appeals to government payers. Our attorneys represent providers in Medicare reimbursement appeals before the Provider Reimbursement Review Board and the federal courts.
MEDI-CAL AND OTHER STATE PAYER REIMBURSEMENT. We have relationships with many state regulators and have resolved numerous state payer disputes for our provider clients either by negotiation or litigation. Representative the issues we have addressed are: administrative claims against Medi-Cal GMC, COHS, and Two-Plan Model plans for payment for emergency services.
COMPLIANCE, FRAUD & ABUSE, FALSE CLAIMS ACT. Our healthcare group is experienced in compliance, fraud and abuse issues, the federal and California False Claims Acts, healthcare licensing issues, Medicare and Medi-Cal reimbursement, billing compliance, managed care, Medicare + Choice Agreements, Physician Incentive Plans, Medi-Cal Geographic Managed Care, Medi-Cal Selective Provider Contracting, Medicare Conditions of Participation and their relationship with JCAHO accreditation standards, Medicare/Medicaid certification and de-certification, the Medicare Professional Review Organization, the Medicare Geographic Classification Review Board, and numerous other complex regulatory programs.
MANAGED CARE/KNOX-KEENE ACT. Sacramento has one of the highest managed care penetration rates in the nation. Our healthcare attorneys have been and remain actively involved at multiple levels in the evolution of this market, representing health systems and hospitals, including major teaching hospitals, skilled nursing facilities, IPAs, multispecialty groups and other professional groups and individual physicians. We have substantial practices in structuring managed care relationships, contracts, and prosecuting and defending payment disputes.
CORPORATE, PARTNERSHIP AND SECURITIES. We have a substantial practice on behalf of numerous for profit and tax exempt entities, both in and out of the healthcare industry. Incorporation, partnership and limited liability company formation, tax planning, mergers, acquisitions, dissolutions, public and private capital development, securities, and numerous similar business issues are routinely handled by the attorneys in our firm. We have special expertise in advising providers on matters related to insolvency.
TAX. We handle the range of services from planning through controversy engagements in the areas of income, estate and gift, property and sales tax. Our experience includes tax exempt determinations and operations, intermediate sanctions, and property tax exemptions
CIVIL LITIGATION. Healthcare providers like other businesses sometimes become involved in business litigation with suppliers, tenants, contractors, governmental agencies, third party payers, business associates, physicians, competitors and other parties. We have seasoned trial lawyers at our firm who focus on these areas.
LICENSING AND CERTIFICATION. Whether you are building or expanding a distinct part skilled nursing facility, constructing a remote outpatient clinic, seeking Medicare certification for a surgical center that is exempt from licensure, attempting to downgrade emergency services or have been cited by the Department of Health Services for licensing code violations, we have experience in identifying the applicable standards, advocating your interests, and working with licensing personnel at both the local and statewide levels to expedite handling of the problem. We are particularly knowledgeable in the complex and often unwritten interrelationships between licensing and reimbursement policy.
LABOR AND EMPLOYMENT LAW. We have a substantial labor law and employment law practice representing management in many industries, including the healthcare industry. Our practice includes dealing with unions, the National Labor Relations Board, wrongful terminations, EEOC and similar discrimination complaints, OSHA, and similar employment law concerns.
ANTITRUST. We are experienced in the application of the antitrust laws to the healthcare industry. A healthcare provider confronts antitrust issues when it subjects a physician to disciplinary proceedings, considers merging with a competitor, enters into alliances or joint ventures that will affect referral patterns, enters into exclusive contracts with hospital-based physicians or third party payers, structures PPO's involving a significant segment of the provider community, or if it possesses a unique market advantage and desires to exploit it. In each case it needs to clearly understand the antitrust issues, and to avoid potentially costly violations. It also needs to have answers quickly so that market-driven opportunities are not lost to intractable analysis.
FACILITY CONSTRUCTION. Completing a construction project on time and in full compliance with the Seismic Safety Act, Life Safety Codes, Uniform Building Codes and the California Administrative Code can be a very challenging and frustrating process. We are experienced in all phases of construction law, can advise you on construction contracts and financing, on how to deal with contractors and sub-contractors when things start to go wrong, and can effectively represent your interests if litigation arises.
TAX EXEMPT FINANCING. We have represented hospitals and other providers in numerous tax exempt bond financings and refinancings. We are familiar with the underwriters and insurers interested in tax exempt bonds, bond counsel and the government officials involved in the issuance and insurance of tax exempt bonds. We are familiar with how bond covenants can affect a healthcare institution and have negotiated successfully various of the standard covenant terms, as well as restructured hospital corporations to remove certain activities from the application of these covenants. We have represented hospitals that were concerned about defaults under their bond covenants. We are familiar with the various consequences of such defaults, can advise facilities and lenders on alternative courses of action.
REAL ESTATE DEVELOPMENT. We have represented hospitals and hospital affiliates in the development of numerous medical office buildings, outpatient diagnostic and treatment facilities, psychiatric facilities, skilled nursing facilities, and general acute care hospitals. Legal vehicles include simple development, joint ventures, condominiums, limited partnerships, leasing and management arrangements. We are very familiar with all of the legal documents and issues presented by such projects both from the perspective of representing real estate developers, construction firms, land owners, and lenders to the building industry, and from the perspective of the non-profit hospital in need of development vehicles that will maximize return, provide integration opportunities with medical staff members or assist in physician recruiting, and comply with and take advantage of licensing and reimbursement rules, but that will avoid inurement, private benefit and unrelated business taxable income problems as well as kickback and self-referral prohibitions.
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