The Health Care practice group at Armstrong Teasdale is dedicated to providing practical legal advice and effective solutions to help health care clients manage their businesses within an evolving regulatory environment. The attorneys within the Health Care practice group represent virtually all types of providers in the industry, assisting with the implementation of the latest legal trends and regulatory controls.
Health care clients must deliver the best care and variety of options for their customers to ensure the success of their businesses. We assist clients in reviewing routine and complex business issues, meeting both the challenges of day to day compliance and identifying potential problem areas in accordance with the latest regulatory trends and best practices. This proactive approach offers clients targeted solutions and realistic advice concerning such matters as corporate structure, regulatory compliance and financing, minimizing liability and litigation avoidance.
Due to the nature of the health care industry, situations often arise that require an immediate legal response, and a client may need to consult with an attorney at unpredictable times. We are committed to providing services beyond normal businesses hours and offer the preparation needed to quickly react at a moments notice.
Key areas of counseling within the Health Care practice group:
- Certificate of Need. Offer advice to clients on a broad range of issues relating to compliance with state certificate of need requirements for hospitals, long-term care providers and other providers, including analyzing threshold questions involving expenditure minimums and covered health services definitions, preparing certificate of need applications and exemption requests, representing clients before the applicable state planning boards, obtaining advisory opinions and rulings and representing clients in compliance/administrative appeals and judicial review proceedings.
- Fraud and Abuse Issues. Counsel clients concerning the fraud and abuse implications of existing and proposed business arrangements, and assist in structuring business arrangements to comply with state and federal fraud and abuse requirements, including the anti-kickback “safe harbors” and Stark law exceptions. We also have experience in obtaining fraud and abuse advisory opinions, as well as more informal guidance from the relevant regulatory authorities.
- Health Care Financing. We have extensive experience in handling tax-exempt and other financing matters involving health care providers, including secured and unsecured borrowings, pass-through financings, loan workouts and restructurings. This experience also encompasses public and private offerings, fixed and variable rates, unenhanced credit, and credit backed by bond insurance and letters of credit. We also serve as counsel for all parties in tax-exempt bond financings throughout the Midwest.
- HIPAA Compliance. We advise clients with compliance with the administrative simplification provisions of the Health Insurance Portability and Accountability Act of 1996, including questions pertaining to confidentiality and access to individually identifiable health information, technological security of electronic medical records and applicability of the electronic transaction standards. We also provide assistance to many of existing clients in developing HIPAA-compliant policies and procedures and related forms.
- Investigations. We assist clients in reviewing their ongoing corporate compliance programs, including internal audits, investigations and legal review of exposures to false claims and other governmental claims.
- Licensing, Certification and Accreditation. We provide advice to individual and institutional clients regarding compliance with licensure, certification, and accreditation requirements, including issues related to scope of practice, alleged disciplinary infractions, collaborative practice, facility surveys and responding to statements of deficiencies, among others. In addition, we work with state and federal regulators and licensing boards to resolve issues and, when necessary, represent clients in the defense of adverse actions.
- Long-Term Care. We represent individual facilities, multi-facility groups, hospital-based SNFs, proprietary and not-for-profit entities, management groups, and nursing home administrators and nurses in regulatory and operational issues. We have successfully challenged state and federal sanctions in state and federal administrative hearings and in federal court, frequently advising clients dealing with investigations by state licensure agencies, state attorneys general, DHHS OIG’s office and U.S. Department of Justice.
- Medical Staff Issues. We counsel hospitals, as well as individual health care professionals with questions involving medical staff activities, policies and hospital bylaws, including but not limited to, malpractice insurance issues, peer review and credentialing activities, National Practitioner Data Bank reporting, disciplinary activities (including summary and automatic suspension hearings), revocation of clinical or admitting privileges, medical staff membership issues and the role of allied health professionals.
- Managed Care. We represent providers and payors in core activities such as negotiating network arrangements, preparing letters of intent and drafting participating provider contracts. In addition, we have also counseled clients in managed care credentialing matters, state and federal government contracting, managed care fraud and abuse issues, insurance regulatory compliance matters, and securities exemptions, offerings and registration matters.
- Medicare and Medicaid Reimbursement. We counsel health care providers and other entities concerning Medicare and Medicaid billing and reimbursement issues, reassignment requirements and billing and collection arrangements, and represent clients in negotiating with regulatory agencies and appealing rate and overpayment determinations.
- Operational Matters. We are experienced a wide variety of day-to-day health care policy and procedural matters, including issues related to state licensure and JCAHO compliance, physician retention and recruitment incentives, informed consent, patient rights, advance directives, commitments and guardianships, institutional research, graduate medical education and other clinical education programs, charity care policies, hospital-based physician arrangements and supply contracts, among others.
- Risk Management/Malpractice Defense. We work with clients and their risk managers to address potential liability issues. We help identify potential problem areas, including the development of new incident and claims investigation policies and procedures, training staff on issues such as defensive documentation and incident investigation procedures. The Health Care Litigation practice group has a long and successful history in defending health systems and individual health care providers, including self-insured providers.
- Strategic Planning. We are very experienced team players capable of working with boards, management, employees and consultants to achieve cost-efficient solutions utilizing state of the art technology.