- Our healthcare attorneys concluded a successful arbitration proceeding against a national managed care company on behalf of a large network of physicians and hospitals. Duane Morris handled this matter on a partial contingency fee basis. We approached this assignment with four goals: 1) recover payments owed under the existing contracts; 2) negotiate a new, more favorable managed care contract with the payor; 3) ensure ongoing audit procedures under the new contract; and 4) preserve the ongoing relationship between our client and the payor.
- We have also negotiated a number of favorable managed care contracts on behalf of a variety of physician practices.
- We structured and implemented various physician-hospital joint ventures in the specialties of radiation oncology, radiology and cardiology. Our attorneys negotiated exclusive contracts involving hospital-based physicians in the specialties of anesthesia, radiology and emergency medicine. We also negotiated and closed on the purchase of a number of ancillary services by a large ophthalmology group from a leading eye hospital.
- Our healthcare attorneys developed a physician incentive compensation plan for a large faculty practice plan as part of a total restructuring of the faculty practice plan.
Services for Hospitals
- Our healthcare attorneys have developed corporate and HIPAA compliance programs for hospitals, organized medical staff foundations and converted tax-exempt hospitals into taxable entities. We obtained separate EIN numbers under a group exemption request for medical faculty plans operating as divisions of a parent healthcare system.
- We represent hospitals in all aspects of their relationships with the medical staff, and have conducted and achieved successful outcomes in many medical staff hearings and subsequent litigation.
- We have structured and implemented various physician-hospital joint ventures in the specialties of radiation oncology, radiology and cardiology, including telemedicine services for a hospital radiology department.
- Our attorneys have successfully negotiated managed care, global billing, exclusive and other contracts for hospitals involving anesthesia, radiology, emergency medicine and transplantation services.
- We have assisted hospitals to secure and maintain their designation as trauma units, and we regularly secure state and federal regulatory approvals for hospital clients.
- We represented more than 100 providers owed over $50 million by a Medicaid managed care organization in liquidation to ensure adequate compensation through the state liquidation process and from the Medicaid oversight agency.
- Our attorneys also assisted in forming several unique federally qualified health centers (FQHCs).
- We developed a HIPAA preemption analysis focusing on home health and health plan operational issues for a large home health agency with many subsidiary businesses.
- Represented three nonprofit community hospitals and resulting "community benefit foundations" in connection with the sale of hospital assets to for-profit hospital chains.
Long Term Care and Senior Services
- We have defended nursing homes, home health agency and ancillary service provider clients under investigation for Medicaid fraud, advising them on appropriate responses to subpoenas and strategizing to minimize the risk of an adverse outcome.
- For many long-term care and assisted living providers, we have developed corporate compliance programs, including HIPAA compliance plans.
- We regularly conduct internal investigations for long-term care and assisted living provider operations and we have successfully negotiated with federal and state agencies for voluntary refunds of Medicare and Medicaid funds as a result of internal investigation findings.
- We have defended numerous nursing homes in connection with state and federal agency findings on quality of care surveys.
- We are general counsel to the Illinois Health Care Association.
- We represent a long-term care group purchasing organization whose founding members are eight of the largest long-term care and assisted living providers in the country owning in the aggregate more than 1,700 facilities.
- We represented a tax-exempt long-term care and assisted living provider in its acquisition of skilled nursing facilities financed through the issuance of tax-exempt bonds totaling in excess of $25 million.
- We represented a skilled nursing facility in a court proceeding challenging a denial of a request for additional reimbursement under the Medicaid program.
- We represented a nursing home in the acquisition of land to build a replacement facility, obtaining HUD-guaranteed financing and obtaining state CON approvals.