Health Law Practice
Few industries undergo the type of continual transformation that defines the health care industry in the United States. Whether your company provides health care, develops information technology or researches and develops new medical drugs and devices, you are subject to complex regulatory and business risks at multiple levels. Likewise, if you are a physician and other non-institutional provider, you need timely and practical advice that can help you not only grow your practice but also potentially avoid costly legal pitfalls.
Responding to these issues with experience and personalized service has earned Fox Rothschild its reputation as a leading national health law practice. We work with our clients -- locally, regionally and across the nation -- carefully reviewing each situation to determine options and tailor solutions to fit the circumstances at hand and the individuals involved.
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Health Law Services
- health care joint ventures
- corporate structuring and governance
- compliance audits and investigations
- dispute resolution
- regulatory compliance
- fraud and abuse
- governmental affairs and lobbying
- managed care contracting
- physician employment arrangements
- physician recruitment and retention
- practice formation, dissolution, and reorganization
- physician buy-ins and buy-outs
- practice mergers and acquisitions
- facility licensing/certificates of need
- reimbursement disputes and appeals
- Medicare and Medicaid
- managed care contracting
- legal guardianships, patients’ rights, and bioethical issues
- medical office building/real estate transactions
- professional malpractice defense and risk management
- federal and state investigations
- labor, employment, and human resources
- medical staff issues
- HIPAA privacy and security
- health information technology
- provider network formation
- assisted living/personal care
- long-term care/nursing homes
- physician compensation and benefits
- medical device approval
- scientific misconduct
- self-insurance plans
- asset protection
- peer review and credentialing
- professional licensure/disciplinary proceedings
- restrictive covenant enforcement and challenges
- tax-exempt bond financing
- not-for-profit tax issues
- financial reorganizations and workouts
- graduate medical education
- white collar crime
Health Law Matters
Formation and Governance
- 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 Regional Health Information Organizations (RHIOs) on formation and governance issues
- 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)
- Formed one of the largest single-specialty physician group practices in southeastern Pennsylvania
Regulatory Counsel and Services
- 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 in Pennsylvania
- Counseled a New Jersey hospital through its transition from Chapter 11 bankruptcy to the purchase of its assets by a New Jersey business group, providing guidance in corporate transaction, third-party payor, medical compliance and regulatory issues
- Provided regulatory counsel regarding relationship between hospital and federally qualified community health center and maintenance of primary care services following closure of hospital facility
- 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 United States Department of Health and Human Services
- Provided regulatory counsel to ambulatory care facility, including, reimbursement, managed care contracting and payment issues and physician contracting issues
- Served as New Jersey counsel to 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
- 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
Medicare and Medicaid Payment Issues
- 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
- Advised a western Pennsylvania radiology practice on taking over the employment of, and negotiating favorable contracts of, another radiology group, significantly increasing our client’s market share
- Negotiated a multi-year contract for a western Pennsylvania radiology group to provide services to a health system, resulting in substantial revenues for our client for a number of years
- Negotiated a western Pennsylvania pediatric practice’s long-term employment contracts with a local hospital
Mergers, Acquisitions, and Joint Ventures
- Designed complex hospital-physician clinical co-management, equipment leasing and other joint ventures for multiple hospitals in New Jersey and Pennsylvania
- Assisted a Pennsylvania hospital contemplating acquisition of a neighboring hospital in due diligence and analysis of regulatory issues. The transaction was eventually abandoned due to financial feasibility issues
- 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 a transaction to merge a central New Jersey radiology practice with another practice in a manner consistent with the client’s existing corporate agreements and in the most tax advantageous manner. Counseled the practice in connection with the merger on shareholder agreements and other employee-physician agreements
- Designed the structure of, and counseled a radiology practice in 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
Sale of Practice or Ownership
- Represented physician investors in connection with sale of majority ownership in a Class C licensed ambulatory surgical facility to institutional investor
- Designed the structure of, and counseled a multi-state cardiology practice in connection with an asset sale coupled with a multi-year provider agreement for clinical and interventional cardiology services between the client and a Pennsylvania hospital system, taking into account regulatory, billing, fee structure and related matters.
- Represented an anesthesia group in connection with the sale of its large medical practice with offices in three states
- Represented a solo practitioner physician in the multi-million dollar sale of his medical practice and surgery center to another physician
- Represented a New Jersey hospital in complex litigation related to 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
- Settled a $634,000 refund demand on behalf of a physician practice for $200,000
- Defended a physician in a medical board action with a result of no fines and no reporting
Medical Staff Issues
- Represented a New Jersey hospital and medical staff in 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 and regulations and policies to comply with recent changes to JCAHO Medical Staff Standards
- 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
Health Law for Institutions
Our Health Law Practice is comprised of attorneys who counsel clients locally, regionally and across the nation. We are experienced, practical lawyers who have served as in-house or outside counsel to nearly every type of institutional health care provider. Our multioffice, multidisciplinary approach allows us to offer practical, cost-effective solutions to the complex problems faced by providers and payers and a variety of industry newcomers.
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Health Law for Institutions - Services
We provide comprehensive representation to all types of institutional health care providers, including but not limited to hospitals, health systems, nursing homes, assisted living facilities, ambulatory surgery centers, diagnostic testing facilities and other ancillary providers. Our services include assistance with:
Health Law for Institutions - Representative Matters
Our diverse background and team management strategy provides the support our clients need in a variety of areas, including but not limited to:
Health Law for Physicians
Health care is one of the most highly regulated industries in the United States, and nearly every day, new issues and challenges seem to arise. Physicians and other non-institutional providers need timely and practical advice that can help them not only grow their practices but also potentially avoid costly legal pitfalls. We work with our clients, carefully reviewing each situation to determine options and tailor solutions to fit the circumstances at hand and the individuals involved.
Fox Rothschild’s health law attorneys have a comprehensive understanding of the needs of individualized physicians, group practices and other non-institutional providers. We aim to help clients anticipate and avoid problems before they arise by providing updates about federal and state regulatory changes that will affect their practices.
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Health Law for Physicians - Services
Our attorneys are experienced in both business and tax counseling as well as matters specific to health care law. Clients seek the assistance of our Health Law Group for a wide range of issues – from determining the proper choice of entity for the practice (professional corporation or limited liability company), how its members become partners/shareholders and how their compensation should be determined to strategic business planning for the ongoing growth of the practice. Our services include guidance in connection with:
- Asset protection
- Billing and collection
- Contractual agreements governing physicians entering and leaving a practice
- Corporate practice of medicine
- Corporate structuring and governance
- Hospital contracts
- Estate and tax planning
- Financial reorganizations and workouts
- Joint ventures
- Labor, employment and human resource issues
- Medical office building/real estate transactions
- Nonprofit tax issues, including tax-exempt bond financing
- Evaluation, negotiation and documentation of agreements (including exclusive provider agreements) between physicians and medical groups with hospitals and other facilities
- Physician buy-ins and buy-outs
- Compensation and benefits for physicians
- Recruitment, retention and employment arrangements for physicians
- Formation, dissolution and reorganization of practices
- Practice management issues
- Practice mergers, sales and acquisitions
- Private inurement/private benefit tax issues in hospital joint ventures and other business transactions and investments
- Restrictive covenants
- Structuring practice transactions
- Succession planning
The health care industry – as one of the largest and most heavily regulated in the county – faces a unique set of legal and business issues, including regulatory compliance, credentialing, fraud and abuse and payment issues. Our interdisciplinary team of skilled attorneys, knowledgeable in every sector of the health care industry, assists clients in responding to these challenges by offering practical advice on how to deal with the complexities of:
- Agreements with managed care networks and third-party payers
- Dispute resolution
- Facility licensing/certificates of need
- False claims prohibitions
- Federal and state compliance audits and investigations
- Federal and state anti-kickback and self-referral laws, including the federal Stark law
- Health information technology
- HIPAA privacy and security
- Legal guardianships, patients’ rights and bioethical issues
- Managed care contracting
- Medical device approval
- Medicare, Medicaid and third-party payer contracting, compliance and reimbursement
- Medical staff bylaws, credentialing, disciplinary hearings and other peer review processes
- Patient Protection and Affordable Care Act (PPACA) and the formation of ACOs under PPACA
- Professional licensure/disciplinary proceedings
- Professional malpractice defense and risk management
- Provider network formation
- Reimbursement disputes and appeals
- Restrictive covenant enforcement and challenges
- Scientific misconduct
Health Law for Physicians - Representative Matters
- Represented a five-member orthopedic group with the sale of its assets and physical therapy operation to a dominant health insurer, including the negotiation of signing bonuses and seven year employment contracts with favorable guaranteed salaries.
- Represented a large pulmonary and critical care group in NJ in the sale of its practice to a health system including the formation and governance of the new hospital-owned entity and the ongoing compensation arrangements for the selling physicians.
- Represented a large orthopedic, sports medicine and pain management group in the sale of its stock to a hospital and the organization of a hospital-owned entity that the physicians continue to manage on a day to day basis.
- Represented a primary care physician group in the sale of its assets to a health system and the formation of a separate stand-alone subsidiary jointly managed by the hospital and physicians with a favorable bonus and subsidy formula. This structure served as the model for this health system's acquisition and employment of many additional primary care practices.
- Represented a cardiology group with offices in PA and Ohio in the negotiation and sale of its practice to a Catholic health system and the development of employment and compensation arrangements.
- Designed the structure of, and counseled a multistate cardiology practice in connection with, an asset sale coupled with a multiyear provider agreement for clinical and interventional cardiology services between the client and a Pennsylvania hospital system, taking into account regulatory, billing, fee structure and related matters.
- Provided legal counsel to a growing cardiology practice in a variety of matters ranging from work on medical practice acquisitions, joint ventures with hospitals, regulatory and compliance matters and structuring medical practice arrangements, to responding to changing insurance company practices.
- Represented physician investors in connection with the sale of a majority ownership in a Class C licensed ambulatory surgical facility to an institutional investor.
- Represented an anesthesia group in connection with the sale of its large medical practice with offices in three states.
- Formed one of the largest single-specialty physician group practices in southeastern Pennsylvania.
- Negotiated a multiyear contract for a western Pennsylvania radiology group to provide services to a health system, resulting in substantial revenues for our client for a number of years.
- Advised a western Pennsylvania radiology practice on taking over the employment of, and negotiating favorable contracts of, another radiology group, significantly increasing our client’s market share.
- Negotiated a western Pennsylvania pediatric practice’s long-term employment contracts with a local hospital.
- Represented Pennsylvania and New Jersey medical practices in voluntary disclosures and refunds of identified Medicare overpayments.
- Advised Pennsylvania and New Jersey physicians in a variety of licensing matters, including physician disciplinary proceedings, before various state licensing boards and other regulatory agencies.
- Designed the structure of a transaction to merge a central New Jersey radiology practice with another practice in a manner consistent with the client’s existing corporate agreements and in the most tax advantageous manner. Counseled the practice in connection with the merger on shareholder agreements and other employee-physician agreements.
- Designed the structure of, and counseled a radiology practice in 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.
- 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.
- Drafted legislation permitting the approval of up to five urban-area accountable care organizations (ACOs) for participation in a Medicaid-Fee-for-Service (FFS) gain sharing project
- Represented a solo practitioner physician in the multimillion-dollar sale of his medical practice and surgery center to another physician.
- Settled a $634,000 refund demand on behalf of a physician practice for $200,000.