The managed healthcare system of today is often the center of public and private controversy, and must operate within a virtual maze of state and federal regulation. Healthcare delivery organizations, contracting entities, and the physicians and other healthcare providers that work within the system are often a lightning rod for litigation from public and private sources. Besides dealing with measures such as the Prospective Payment System and other laws that affect the industry, healthcare providers and networks must deal with employment issues, patient treatment and satisfaction, contracts, mergers and acquisitions and other issues. The firm has represented some of the largest and most well known healthcare delivery and management organizations in these matters, and maintains a proactive stance in assisting our clients with such ongoing regulation and issues. The experience the firm has accumulated with our clients, from individual doctors to the largest managed care organizations, has given us the legal know-how to ably assist you in areas of healthcare law such as:
Provider Operations/Regulatory Compliance
The day-to-day affairs of today's health care providers often involve complex contractual and regulatory issues that require the assistance of legal counsel, and include areas such as:
- Drafting/negotiating vendor, patient and employment contracts/agreements
- Peer review confidentiality
- Payor issues
- Corporate structure and administration issues
- Patient dumping
- Licensure
- and other areas
Managed Care Organizations
Today's healthcare system is a managed care universe, in which HMO's, PPO's, PPM's, IPA's, ALF's and other healthcare providers and management organizations exist in an ever-changing regulatory environment. Some of the areas in which managed care entities need guidance in include:
- Creating and maintaining capitated physician networks
- Managed care contracts
- Public and private payor issues
- Provider HMO risk sharing agreements
Physician Groups/IPA's
The profession and practice of medicine has changed considerably since the turn of the century, from house calls to home healthcare, from the rural general practice to the highly specialized professionals of today. The concerns of physicians today include matters such as the encroachment of managed care on physician decision-making and HMO credentialing, and they often turn to legal counsel for assistance with issues including:
- Corporate practice of medicine
- Labor/Employment issues
- Medicare Part B and Medicaid payments
- Self-referral laws
- Licensure, board certification and revocation
- Private third party payor disputes
- and a variety of other issues
Fraud/Abuse
In addition to the more ordinary corporate and regulatory matters which healthcare providers, managed care and practice management companies must deal with, they must also be vigilant of fraud and abuse in billing and related areas, and often must seek assistance in matters such as:
- Criminal, civil and administrative proceedings
- Patient billing fraud, including unnecessary and double billing
- Abuse and fraud in physician/hospital arrangements
- Medicare/Medicaid fraud
- Related compliance issues
- and other fraud and abuse related issues
