KEYWORD:

Health Care

Health care is among the most complex, fiercely competitive and highly regulated industries in the country. Constantly expanding technologies and regulatory requirements place ever-increasing demands on health care providers and payers for more and better products and services at lower costs. A thorough understanding of these demands and their impact on health care delivery and financing is absolutely critical to providing quality legal services to health care clients.

The Health Care Law Team of Adams and Reese understands the complexities of health care. Our team is an integrated, multi-disciplinary group designed to efficiently and cost-effectively provide a full range of legal services that health care clients expect and demand. The group includes lawyers with extensive experience in health care delivery and financing and experience in areas having special application, including: health care, including tax, labor and employment, intellectual property, environmental, governmental relations and antitrust law; and all types of health care litigation and administrative proceedings. The Health Care Law Team marshals the firm's substantial capabilities and resources to help our clients navigate and succeed in the constantly changing health care marketplace.

AREAS OF PRACTICE

• Business Organization, Corporate and Contractual Legal Services Advising and counseling providers, payers and other health care entities on all legal matters relating to the organization, structure and operations of health care facilities, professionals and third party reimbursement programs.
• Clinical Research Issues Advising and counseling clients on: evolving legal issues arising in clinical research, including informed consent and related human subject protections; Institutional Review Board functions and operations; HIPAA and other privacy issues; and Medicare and Medicaid billing for products and devices in clinical trials.
• Corporate Compliance Programs Designing and implementing comprehensive corporate compliance plans encompassing Medicare and Medicaid billing and all other regulatory compliance risk areas for hospitals, physician practices, clinical laboratories, home health agencies, long-term care facilities and other health care providers.
• EMTALA Compliance Advising hospitals and physicians on compliance with the Emergency Medical Treatment and Active Labor Act and responding to regulatory inquiries and investigations on EMTALA compliance, including plans of correction.
• Fraud, False Claims Act and Civil Sanctions Advising hospitals, physicians, long-term care facilities, home health agencies and other health care providers on all aspects of government anti-fraud and False Claims Act enforcement, including application to quality of care issues.
• Health Care Financing Representation of clients in negotiation and closing a variety of financial transactions, including conventional loans and other debt financings, private placements and subordinate issues, tax-exempt bond issues and Initial Public Offerings, and workouts of problem loans involving health care providers.
• HIPAA and Medical Records Complete assistance in all phases of compliance with HIPAA standards and other regulations governing maintenance and disclosure of medical records including: guidance on HIPAA implementation; drafting, reviewing and approving policies, forms, agreements and related documents; interpretation of privacy regulations; incorporation of HIPAA into existing compliance programs; and creating and presenting educational programs on HIPAA and related medical records issues.
• Illegal Remuneration, Stark Law Advising hospitals, physicians and other health care providers on compliance with federal and state laws and regulations governing financial relationships among sources and recipients of referrals for health care products and services, and responding to regulatory scrutiny of those relationships.
• Joint Ventures, Mergers and Acquisitions Mergers, acquisitions and joint ventures, including joint ventures involving patient referral sources and recipients in compliance with the federal Stark and anti-kickback statutes.
• Licensure, Certification and Accreditation Advising and counseling clients on Certificate of Need and other issues of licensure, certification and accreditation, including state and federal laws, regulations and guidelines, and requirements of independent accreditation agencies such as JCAHO, NCQA and URAC.
• Managed Care Advising and representing of health care providers and payers in connection with laws and regulations governing managed care arrangements, including financial risk-sharing among providers and payers, utilization review activities, timely claims payment, "any willing provider" laws and the impact of ERISA preemption on state statutes and regulations governing managed care.
• Professional Disciplinary and Other Medical Staff Issues Representation of hospitals, managed care organizations, regulatory authorities and medical staff leadership in discharging their responsibilities of: physician oversight, including drafting, revising and interpreting Medical Staff Bylaws and related policies and procedures; credentialing and peer review activities under the Health Care Quality Improvement Act; and creating educational materials and programs relating to medical staff issues, including EMTALA, clinical research and general corporate compliance issues.
• Reimbursement: Representation of providers in Medicare Part B reimbursement disputes and other issues associated with third-party reimbursement by private insurers, Medicare and Medicaid.

INDUSTRIES SERVED

Public and Private Tertiary Care Hospitals
Rehabilitation Hospitals
Specialty Hospitals
Ambulatory Surgery Centers
Imaging Centers
Dialysis Clinics (and other ancillary service providers)
Long-term Care Facilities
Home Health Agencies
Physician Groups and Clinics
Individual Physicians (and other health care professionals)
Medical Staffs
Pharmacies and Pharmaceutical Companies
HMOs, PPOs (and other managed care organizations)
Pharmacy Benefits Management Companies
Integrated Delivery Systems and Networks

REPRESENTATIVE MATTERS

• Represented a group of physician investors through a successful private stock offering and secured debt financing for the development and construction of a physician-owned specialty hospital.
• Represented hospital in CMS investigation of EMTALA complaint and preparation and submission of plan of correction.
• Advised and counseled hospital regarding clinical research and Institutional Review Board activities.
• Represented hospital system in all aspects of implementing HIPAA privacy regulations.
• Represented hospital in sale of home health business.
• Advised and counseled hospital on complete amendment and restatement of medical staff bylaws.
• Represented long-term care facility in preparing plan of correction and responding to subsequent regulatory investigation based on significant quality of care issues disclosed by survey.
• Advised and counsel on creation of a dental services corporation.
• Designed and implemented of comprehensive corporate compliance program for hospital system, including hospital-owned home health agency, skilled nursing facility, rehabilitation hospital and physician practices, and on-going advice regarding enforcement of same.
• Represented physicians in joint venture with hospital for PET scan facility.
• Represented hospital in joint venture with physical therapy clinic for physical and occupational therapy services.
• Advised various physician groups on compliance with Stark guidelines in providing in-office MRI, echocardiography and other designated health services.
• Advised MRI service provider regarding Stark requirements applicable to physician investment and referrals.
• Represented long-term care facilities in responding to regulatory inquiry regarding joint venture to provide institutional pharmacy services.
• Represented statewide business healthcare coalition and preparation of group purchasing agreements among employers, insurers and healthcare providers.
• Represented hospital in a variety of credentialing and other professional disciplinary matters.
• Represented physician practice in formation of a management company.
• Created self-insurance hospital trust.
• Created a medical malpractice insurer, and work with the insurance department on same.
• Analyzed antitrust issues involving a variety of healthcare problems.
• Prepared AIDS, alcohol and drug policies in connection with the preparation of employee handbooks and other materials.
• Handled foreclosure of a hospital for bond trustee, involving a lawsuit to extend a CON.
• Planned and supervised workout of problem loans involving health care providers.
• Prepared estimate for major computer hardware and software purchased by a hospital.

ABOUT OUR TEAM

Our Health Care Law Team is built around a group of partners who practice, write and speak about health care-related legal issues. One of our members holds a Masters Degree in Public Health, with a concentration in Health Care Organizations and Policy. Another member was the Vice President of Legal and Governmental Affairs of the Louisiana Hospital Association for over eight years, and is the editor of "Louisiana Medical Records Law," a health care textbook used by two Louisiana colleges. Another partner applies her experience in trademark and copyright law to her health care clients.

Members from our team sit on various health care-related associations. These include:

• The Advisory Board of the Health Care Compliance Association (Region 6)
• The Institutional Review Board of Our Lady of the Lake Hospital
• The Ethics Committee of Earl K. Long Medical Center
• The American Health Lawyers Association
• The Health Law Section of the American Bar Association

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