Our diverse background and team management strategy provides the support our clients need in a variety of areas, including but not limited to:
Mergers, Acquisitions and Joint Ventures Matters
- Designed complex hospital-physician clinical co-management, equipment leasing and other joint ventures for multiple hospitals in New Jersey and Pennsylvania.
- Provided legal counsel to the manager of several New Jersey hospital-physician clinical co-management companies in connection with numerous hospital-physician clinical co-management arrangements to ensure arrangements involved active physician participation and satisfied Medicare and other applicable regulatory requirements.
- Represented a Pennsylvania hospital in the development of an urgent care center joint venture with a local physician group.
- Assisted a Pennsylvania hospital contemplating the acquisition of a neighboring hospital in due diligence and analysis of regulatory issues. The transaction was eventually abandoned due to financial feasibility issues.
- Represented a closely held home health agency in its sale to a national home health care company for $34 million.
- Represented Honor Health Network, LLC, the largest post-acute care network in central Pennsylvania, in an asset sale transaction of a nursing home and other health care ancillary businesses.
- Structured joint ventures and other strategic alliances between an exempt organization and for-profit health care entities.
- Assisted a hospital in the acquisition of a physician-owned ambulatory surgery center (ASC) and the restructuring of an existing hospital ASC.
- Designed the structure of, and counseled a radiology practicein connection with, a joint venture for outpatient imaging services between the client and a New Jersey hospital, taking into account potential tax consequences for both parties.
Legislation and Policy Advocacy Matters
- Drafted legislation establishing a Medicaid Accountable Care Organization (ACO) Demonstration Project in New Jersey which enables the formation of voluntary, community-based ACOs to develop high quality, cost effective healthcare solutions in urban areas. The bill was signed by Governor Christie in August 2011.
- Asked to assist the New Jersey Medicaid program in drafting regulations implementing the Medicaid ACO Demonstration Project in New Jersey.
- Advocated policy initiatives on behalf of a New Jersey hospital, including advocacy on bills focused on hospitals’ provision of charity care and access to specialized services within the state.
Regulatory Counsel and Services Matters
- Provided regulatory counsel regarding the relationship between a hospital and a federally qualified community health center and maintenance of primary care services following closure of the hospital facility.
- Addressed regulatory, licensing, Medicare/Medicaid and managed care contracting issues in connection with the relocation of an existing hospital and construction of a new hospital.
- Provided strategic advice related to The Patient Protection and Affordable Care Act (PPACA) and IRS requirements for nonprofit hospitals.
- Counseled a New Jersey hospital through its transition from Chapter 11 bankruptcy to the purchase of its assets by a business group, providing guidance in corporate transaction, third-party payor, medical compliance and regulatory issues.
- Represented New Jersey and Pennsylvania hospitals and medical practices in voluntary disclosures and refunds of identified Medicare overpayments.
- Represented New Jersey and Pennsylvania hospitals in Medicare overpayment settlement negotiations with the Department of Justice and entering into corporate integrity agreements and certification of compliance agreements with the Office of the Inspector General of the U.S. Department of Health and Human Services.
- Provided regulatory counsel to an ambulatory care facility, including reimbursement, managed care contracting and payment issues and physician contracting issues.
- Provided transactional and regulatory services to a large national provider of skilled nursing, rehabilitation, therapy and other sub-acute care services in connection with expansion plans in multiple states.
- Served as independent compliance counsel to the board of trustees of a nationally recognized academic medical center in connection with its corporate integrity agreement with the Office of the Inspector General of the U.S. Department of Health and Human Services.
- Served as counsel to a publicly traded company that operates Medicaid-managed care plans throughout the country. Provided regulatory counsel in a variety of areas including patient appeals and issues related to potential acquisition of another New Jersey Medicaid HMO.
- Advised numerous health care providers, health plans and government entities in compliance issues related to patient privacy arising under state and federal law, including HIPAA.
- Represented New Jersey and Pennsylvania health care facilities in a variety of licensing matters, including physician disciplinary proceedings, before various state licensing boards and other regulatory agencies.
- Served as an independent compliance “expert” as mandated by the hospital’s settlement with the federal government, overseeing an organization-wide, corporate compliance program effectiveness assessment.
Medicare and Medicaid Payment Issues Matters
- Represented a hospital in repayment of wrongfully billed Medicare and Medicaid claims, including engaging outside consultants, presentations to corporate compliance and board committees and negotiations with the Department of Justice, OIG and Medicare/Medicaid fiscal intermediaries.
- Provided legal counsel to a New Jersey hospital on Medicare and commercial insurance reimbursement issues and insurance company disputes.
- Provided advice to the manager and operator of a network of sleep centers in Medicare and commercial insurance reimbursement issues.
- Advised the manager and operator of a network of sleep centers in Medicare and commercial insurance reimbursement issues and other insurance matters.
Formation and Governance Matters
- Prepared a multitude of agreements, governance and formation, drafted medical staff bylaws and addressed regulatory issues involved in the creation of a Long-Term Acute Care Hospital (LTAC).
- Advised the largest New Jersey Regional Health Information Organization (RHIO) on governance, policy development, written agreements and other legal issues relevant to the formation of a RHIO.
- Advised one of New Jersey’s first RHIOs on formation and governance issues
Medical Staff Issues Matters
- Represented a New Jersey hospital and medical staff in a discipline action against a physician for clinical deficiencies in all phases, including initial corrective action, fair hearing, appellate review and administrative hearings.
- Revised a hospital’s medical staff bylaws, rules, regulations and policies to comply with recent changes to Joint Commission medical staff standards.
- Represented a New Jersey hospital in complex litigation related to the waiver of co-pays/out of network benefits.
- Litigated a highly contested and politicized Certificate of Need case in New Jersey on behalf of a consortium of affected hospitals.
- Represented several health insurers in claims to a portion of a $45 million settlement of a class action.
- Represented multiple long-term care facilities in general and corporate liability, professional malpractice and state and local investigations regarding elder abuse.