In today’s world of government spending cuts and healthcare reform, health care facilities must operate more efficiently in the face of declining reimbursement, increased competition, and heightened scrutiny from government regulators. As healthcare continues to shift toward value-based care, healthcare facilities are increasingly confronted by legal issues of all stripes, many of which influence patient care.
Nelson Hardiman’s top-ranked attorneys are committed to helping healthcare facilities thrive in the post-health care reform marketplace. The Nelson Hardiman team represent healthcare facilities in regulatory, transactional, and litigation matters. We combine legal knowledge, tenacity and grit to solve your toughest problems, providing strategic advice and key legal services to hospitals, ambulatory surgery centers, federal qualified health centers (FQHC’s), long-term care and behavioral health facilities.
Nelson Hardiman is a proud strategic partner for industry-leading ambulatory surgery centers (ASCs). We understand the unique challenges facing ASCs, having actively navigated through every phase of an ASC’s life cycle. With surgeons’ services being reimbursed at ever-lower rates by Medicare and insurers, we know it is essential to develop ambulatory surgery centers as successful profits centers essential to the future of the healthcare industry.
Our unique experience serves physicians seeking reimbursement for in-network and out-of-network spaces. Whether you are planning to get into the ASC business or are an existing ASC struggling with compliance or reimbursement issues, Nelson Hardiman provides the strategic counseling and representation to fulfill your business, regulatory or dispute resolution needs.
Our Work Includes:
- Acquisition Advised a non-US buyer with respect to healthcare regulatory issues in a multi-million dollar purchase of stock in nine physician clinics and outpatient surgery centers located in California, Nevada and Florida.
- Arbitration Defended an outpatient surgery center in arbitration with a surgeon alleging deceptive marketing practices in violation of the federal Lanham Act and breach of an exclusive services contract.
- Business Dispute Obtained terminating sanctions and summary dismissal of a complaint filed against a client ambulatory surgery center seeking damages for alleged breach of services contract.
- Class Action Represented out-of-network outpatient surgery centers (ASCs) in federal putative class action against health services businesses and ERISA plans for alleged failure to reimburse ASCs according to a proper methodology for calculating the usual, customary and reasonable (UCR) reimbursement.
- Finance Documented the financing and/or sale of over 25 ambulatory surgery centers.
- Licensure and Certification Advised on licensure, certification and/or related matters for ambulatory surgery centers
- Mergers and Acquisitions Managed due diligence and pre-and post-acquisition notices for venture capital purchase of multiple ambulatory surgery centers and pain clinics.
- Reimbursement Successfully represented an ambulatory surgery center in out-of-network “fee forgiveness” action against a major insurance company. Pursuing more than $3M for claims improperly denied based on claim that surgery center “forgave” patient contribution as inducement for using out-of-network facility.
- Trade Name Dispute Represented ASC in an action against a competing ASC for trade name infringement.
Nelson Hardiman represents behavioral health treatment facilities large and small. We understand how legal and regulatory issues challenge today’s behavioral health facilities, and proactively help our clients address ethical and regulatory concerns within the context of behavioral healthcare and legal dynamics. To that end, we launched the American Addiction Treatment Association to fill a regulatory compliance void in the industry.
In addition to ensuring regulatory compliance, Nelson Hardiman is renowned for the depth of our experience in protecting from claims of fraud and abuse, and advising on policies and procedures related to licensure, certification, and privacy. Long considered the unsung heroes of the healthcare industry, we stand with behavioral health providers and support their commitment to establish new standards of patient care and respect industry-wide.
Our Work Includes:
- Compliance Assisted national substance abuse recovery organization with compliance program design, implementation, and extensive state-level certification and licensure.
- Contempt Prevailed in a trial on behalf of a licensed provider of assisted living services to the developmentally disabled against a former employee for wrongfully poaching clients.
- Fraud Represented a behavioral health facility in a wage garnish issue, stemming from alleged misappropriation of funds by a patient’s relative that were intended for an insurance company.
- Land Use Litigation After lengthy negotiations convinced a city to dismiss a public nuisance action brought against an addiction treatment facility.
- Labor and Employment Obtained a favorable settlement of successive wage/hour and wrongful termination claims brought by employees against a client adult day healthcare provider.
- Licensure Represented behavioral health facilities threatened by denial and non-renewal of licensure, certification, and accreditation by government and accreditation agencies.
- Litigation Won a full judgment against the father of a teenager being treated for addiction for wrongfully pocketing more than $100,000 in insurance proceeds instead of reimbursing a recovery facility.
Nelson Hardiman provides legal counsel to enable Federally Qualified Health Centers (FQHCs) to fulfill their critically important mission as local community healthcare providers. We guide non-profit community clinics through the complicated regulatory framework to form FQHCs. We have worked closely with these community-based organizations, including both Section 330 grantees and “look-alike” FQHCs, to maintain compliance while collaborating on creative solutions for advancing their mission.
We understand the unique challenges that FQHCs face in meeting the needs of stakeholders while complying with the myriad and nuanced requirements of multiple laws and agency regulations. These include the Health Resources and Services Administration (“HRSA”), the Internal Revenue Service (“IRS”), the California Department of Public Health (“DPH”) and the California Department of Health Care Services (“DCHS”). We go beyond traditional legal advice and engage with regulators, contracted and affiliated providers, strategic partners, and Risk Bearing Organizations (RBOs)/health plans. Nelson Hardiman lawyers cut through the complex legal challenges faced by FQHCs and empower our clients to excel at delivering essential primary and preventive healthcare.
Our Work Includes:
- 340b and Contract Pharmacy Arrangements Counseled on strategic participation in the federal 340b drug discount program, and advised in the structuring of contract pharmacy arrangements and compliance with HRSA’s rules and guidelines for contract pharmacy agreements, including negotiating agreements with the contract pharmacies to ensure compliance and fair terms.
- Compliance Advised on compliance with federal and state anti-kickback laws and HRSA requirements, including drafting policies and procedures.
- Corporate formation Handled various aspects of corporate formation and scope of project for funding, including filings with the State and assistance with HRSA forms.
- HIPAA Consulted on HIPAA and California privacy and security requirements.
- HRSA Audit Advised on a HRSA audit that concerned whether the FQHC was meeting the requirements of the Section 340b drug program.
- Medi-Cal Audit Dispute Successfully filed a petition for writ of mandate to overturn a Medi-Cal audit decision by DHCS about whether a clinic operated by a medical center qualified as a FQHC.
- Non–profit status Counseled a non-profit entity and its Board to ensure compliance with IRS rules and avoid private inurement or excess benefit transactions.
- Practice Acquisitions Represented a clinic in the purchase of medical practices in connection with service site additions under HRSA and DPH. Handled all aspects of the transactions, including the purchase agreements and finance documents, due diligence, lease agreements, employment agreements and independent contractor agreements.
A leader in healthcare law, Nelson Hardiman provides mission-critical legal counsel to hospitals and health systems. Known for our innovative and creative approach to solving the most complex issues in healthcare, we offer a depth of experience and insight that healthcare organizations cannot live without.
Nelson Hardiman understands providers must balance the needs of their patients with increased healthcare utilization and cost, decreased federal and state dollars to pay for healthcare costs, and increased government enforcement. We work closely with our clients to meet these challenges, to guard against fraud and abuse and to advise on business operations and transactions. Nelson Hardiman provides hospitals and health systems with the guidance and advocacy that comes with deep integrity and experience in the healthcare industry.
Our Work Includes:
- Acquisition Counseled and documented acquisition of acute care hospitals both in and out of bankruptcy courts, involving workouts and operational turnarounds.
- Complex Business Litigation Represented a national health system in a contract dispute with another health system and its management company involving an unsuccessful purchase of five financially distressed nonprofit hospitals. The case settled favorably for our client the day before trial.
- False Claims Act Defended hospitals in complex federal and state FCA actions involving claims for allegedly non-reimbursable, unnecessary or inflated services and costs.
- False Claims Act Defended 13 hospitals against hospital employee relator submission of false Medicare claims for inpatient admissions.
- HIPAA Counseled healthcare systems on HIPAA and state health information privacy laws and development of privacy compliance programs.
- Hospital Transactions Served as lead transactional counsel on numerous large hospital purchase and sale transactions in California and throughout the U.S.
- Independent Counsel for Hospital Medical Staffs Proactively counsel medical staffs on changes in the law and needed revisions to policies and bylaws, procedural steps in disciplinary actions and advise on professional liability and risk management issues.
- Physician Agreements Represented California hospitals in evaluating, negotiating, and drafting physician agreements, including professional services agreements, administrative services agreements, call coverage, and hospital-based agreements.
- Regulatory Compliance Investigated health care compliance implementation deficiencies for a hospital system and provided recommendations for improving compliance program.
- Stark Law Advised a large nonprofit hospital corporation in internal Stark Law review and self-disclosure of over 2,000 physician compensation arrangements, including significant written analysis of healthcare fraud and abuse issues and self-disclosure documents.
Nelson Hardiman understands the unique healthcare environment of long-term care facilities (LTCFs) – including nursing facilities, skilled nursing facilities, rehabilitation facilities and assisted living facilities. With an unrivaled mix of industry experience, first-hand knowledge of operational issues, and a keen focus on regulatory compliance, our attorneys excel at finding innovative, creative solutions to meet the complex needs of long-term care facilities.
Challenged with providing a wide range of healthcare and related services to patients unable to manage independently in the community, LTCFs must also address operational issues of managed care contracting and reimbursement disputes, professional and institutional licensure by accreditation bodies, and liability and staffing issues involving nursing and medical staff. Simply put, Nelson Hardiman has the legal knowledge, industry experience and strategic vision to navigate today’s exacting legal environment and increasing demand for long-term care facilities and services.
Our Work Includes:
- Acquisition Counseled and documented sale of a chain of skilled nursing facilities.
- Employment Prepared employment contracts, employee handbooks and independent contractor agreements for adolescent homes.
- HIPAA/Privacy and Information Security Counseled long-term care facilities on HIPAA and state health information privacy laws and development of privacy compliance programs.
- Fraud and Abuse Represented a skilled nursing home in relation to nearly $1 million in insurance back fees owed to the government.
- Licensure and Certification Advised on licensure, certification and/or related matters with respect to group homes, social rehabilitation facilities, and other long-term care facility clients.
- Regulatory Compliance Counseled on all regulatory aspects of healthcare, including for skilled nursing, assisted living, sober living, rehabilitation facilities, and related clients.
- Regulatory Compliance Advised rehabilitation facility on legal requirements for the storing and administration of a drug used to resuscitate individuals experiencing an opioid overdose.
- Stark/Anti-kickback Statute Negotiated and implemented corporate integrity agreement on behalf of skilled nursing facility chain following federal investigation of Stark/Anti-Kickback Statute violations.