HEALTH CARE
Our health law attorneys represent hospitals, physicians, managed care organizations and other health care providers throughout the Southeast as counsel on corporate, tax and regulatory matters. We also represent our health care clientele in a variety of health care related areas, including labor and employment, antitrust, employee benefits, intellectual property, financing, securities, and general litigation.
Regulatory Practice and Medicare and Medicaid Experience and Capabilities
Our attorneys represent health care providers on Medicare and Medicaid payment issues. We have extensive experience in handling Anti-Kickback, Stark, and other fraud and abuse issues relating to hospitals, physicians and managed care organizations, and are knowledgeable regarding guidance and the enforcement policies of the Office of the Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS).
We have represented hospitals in connection with the Justice Department's investigation of Medicare reimbursement matters, Anti-Kickback and Stark issues and the civil False Claims Act. We assisted clients in establishing and implementing corporate compliance programs. We represent both physician and hospital clients in matters relative to Medicare and Medicaid billing violations (administrative, criminal and civil).
Our attorneys represent clients in EMTALA matters, including OIG hearings, negotiations with the OIG and administrative appeals. We have assisted clients in complying with JCAHO requirements, and in drafting corporate and medical staff bylaws. We advise clients frequently regarding consent issues and medical record-retention issues.
With regard to state law matters, we advise clients regarding certificate of need laws, Louisiana hospital service district laws and licensure issues. Our health care attorneys stay abreast of Division of Medicaid developments and frequently advise clients regarding Medicaid issues, including payment issues.
We closely monitor Medicare developments and frequently comment on proposed rules on behalf of our clients. We routinely represent clients interested in Medicare provisions in the federal budget bills. We have represented clients' interests to congressional delegations, and we stay abreast of both federal and state health care legislative developments. Because we have excellent relationships with CMS and OIG officials, we are in a position to obtain an authoritative answer to issues that the published rules and regulations may not address.
We handle administrative appeals before the Provider Reimbursement Review Board and have represented groups of hospitals regarding the Medicare disproportionate share statute and other payment issues.
Our lawyers advise clients about the proper structure of provider relationships to avoid antitrust violations, including physician hospital organizations and independent physician associations, implementing messenger model guidelines and counseling providers and rendering opinions in connection with issues regarding collaboration on prices, division of markets, issues of exclusivity and Robinson-Patman questions. Additionally, we assist clients in developing and implementing corporate compliance programs regarding antitrust issues.
Transactional, Corporate and Tax Practice
Our attorneys represent clients in the preparation and negotiation of a variety of transactional and contractual arrangements among a variety of health care providers. For example, we have represented a number of clients in hospital and nursing home acquisitions, purchases/sales/mergers of physician practices, development of integrated delivery systems, acquisitions and sales of HMOs, and organization and syndication of surgery centers, cancer centers, IDTFs and skilled nursing facilities. In addition, we have provided advice to a client in connection with the development and organization of a Program of All-Inclusive Care for the Elderly (PACE).
We advise health care clients on general business and corporate matters and all legal matters involving federal, state and local taxation. We also assist clients in choosing the proper type of entity through which they may wish to offer health care services, including professional associations, business corporations, LLCs, PLLCs and not-for-profit corporations. Our lawyers provide legal advice to clients involved in corporate reorganizations - including restructurings, spin-offs, creating subsidiary corporations, and forming holding companies - and mergers and acquisitions.
Our health care lawyers have increasingly become involved in Internet health care issues. We are actively counseling e-health clients on the complex regulatory issues related to the provision of online medical information, and we are assisting these clients in their general business needs of attaining venture capital, preparing business plans, negotiating licensing and distributorship agreements, as well as general corporate and tax advice.
With regard to tax issues, we assist clients in obtaining tax exemptions and in making ruling requests/applications for exemption before the national office of the IRS. In addition, our lawyers assist health care clients in structuring physician recruitment incentives, medical director agreements and other contractual arrangements between and among health care clients.
We advise employers on a full range of employee benefit matters, including the design and implementation of qualified and non-qualified retirement plans, the design and implementation of welfare benefit plans, participant communication, fiduciary issues, investment matters and prohibited transactions. Our attorneys counsel clients on ERISA issues such as policy statements, plan assets, plan administration, claims review procedures, written records, privileged issues, compliance issues, mandatory disclosures and employee education.
We assist clients in the preparation and negotiation of executive compensation agreements, including golden parachute arrangements, stock option and other long-term incentive plans, split dollar arrangements and other forms of non-qualified deferred compensation arrangements. Frequently our attorneys advise clients on the impact of benefit programs on financial reporting, special concerns relating to tax-exempt and public employers, special compensation concerns of the health care industry, corporate and security law aspects of retirement plans and other compensation arrangements. We represent clients in employee benefit litigation and administrative proceedings, including Department of Labor and IRS audits and fiduciary and benefit litigation. Our attorneys also design, draft or review for compliance group health plans, cafeteria plans, VEBAs and other welfare benefit trusts, design and draft non-qualified retirement plans, Rabbi trusts and 457(f) plans and draft and design qualified retirement plans.
Managed Care Experience and Capabilities
Our health law attorneys represent health care clients in a variety of managed care matters, including:
- Assisting clients in establishing and operating managed care organizations, including HMOs, PPOs, MSOs, PHOs and IPAs
- Assisting providers in applications to market Medicare Select products
- Negotiating provider contracts with, and for, hospitals and individual physicians, as well as with group practices, including a variety of payment arrangements, such as discounted fee-for-service fees, withholds and capitated arrangements
- Developing a variety of contractual arrangements with subscribers and TPAs, including full-service third-party administration and contracts for more limited services, including enrollment, claims payment and utilization review
- Assisting in the development of pharmacy arrangements for managed organizations
- Assisting in licensing TPAs and UR companies.
Additionally, our lawyers are familiar with the ERISA issues involved in establishing managed care plans, the scope of preemption, the requirements for SPDs and related documents, the risks of "bad faith" liability and the preemption doctrine as it relates to possible "bad faith" liability.
We have prepared medical staff bylaws for various managed care organizations and hospitals, including policies and procedures with respect to credentialing and delineation of privileges. We are familiar with the issues that typically arise in managed care organizations with regard to credentialing and re-credentialing, delineation of privileges, deselection, and other matters including antitrust issues. We have participated in numerous administrative hearings and litigation.
