Healthcare

Using a multidisciplinary approach, the attorneys at Hodgson Russ provide counsel to a wide range of health care providers including hospitals, skilled nursing facilities, assisted living providers, home health agencies, hospices, clinics, ambulatory surgery centers, behavioral health providers, clinical laboratories, pharmacies, and individual practitioners. We represent nonprofit, for-profit, and public health care organizations, including some of the largest hospital systems in New York State.

We assist with corporate, transactional, corporate governance, regulatory compliance, privacy, reimbursement, compliance, enforcement, labor and employment, and litigation matters as well as administrative challenges to governmental action, administrative appeals, and arbitration proceedings. With a broad understanding of the New York regulatory landscape, we help clients anticipate and respond to the increasingly complex rules governing the delivery, financing, and regulation of health care services.

Our Experience

Provider Reimbursement Review Board Appeals
Government investigations and enforcement proceedings
New York Certificate of Need
Managed Care Contracts
Healthcare Reform
Health Insurance Portability and Accountability Act (HIPAA) & Privacy
Informal Dispute Resolution (IDR) and IDR Processes
Internal Investigations
Disciplinary Proceedings
Internal Audit and Monitoring
Independent Practice Associations (IPAs)
Health Care Litigation and Dispute Resolution
Health Care Mergers, Acquisitions, and Joint Ventures
Physician self-referral and anti-kickback
Licensure, Certification, and Surveys
Policy & Compliance Programs
NY Social Services Law § 363-d
18 NYCRR Part 521

Audits, Investigations, and Appeals

We represent health care providers in Medicare and Medicaid audits, investigations, and appeals, including Medicare appeals before the Provider Reimbursement Review Board. We also represent health care providers in government investigations and enforcement proceedings before the New York State Department of Health, Office of the Medicaid Inspector General, and Medicaid Fraud Control Unit; the Health and Human Services Office of Inspector General and Centers for Medicare and Medicaid Services; and the U.S. Department of Justice.

Health Care Litigation and Dispute Resolution

Hodgson Russ represents health care providers in federal and state court litigation, administrative challenges to governmental action, and arbitration proceedings with managed care organizations.

Health Care Mergers, Acquisitions, and Joint Ventures

We structure health care mergers, acquisitions, reorganizations, and joint ventures. We advise on the application of New York’s certificate of need requirements to proposed combinations. Our attorneys also provide guidance on antitrust, corporate, regulatory, and tax issues.

Medicare, Medicaid, and Other Reimbursement Issues

We advise health care providers on Medicare and Medicaid billing and reimbursement issues and assist them in analyzing the reimbursement consequences of alternative business structures. We represent providers in Medicare and Medicaid audits and appeals, including Medicare appeals before the Provider Reimbursement Review Board.

Nonprofit Organization and Governance Issues

We advise nonprofit health care boards on best practices in corporate governance and regulatory compliance. Our attorneys assist in the development of charters and bylaws and the formulation of compliance policies. We also assist in conducting internal investigations relating to potential compliance violations, including whistleblower allegations, and in responding to inquiries from governmental agencies.

Physicians, Licensed Professionals, and Group Practice Issues

We negotiate the purchase and sale of physician practices and advise on physician recruitment issues. Our attorneys prepare contracts to comply with fraud and abuse, IRS, and other applicable guidelines. We advise facility administration, physicians, and other licensed professionals on contract negotiations, third-party payor reimbursement, purchases and sales of assets, and medical staff credentialing and disciplinary issues. We represent physicians and other licensed health care professionals in disciplinary proceedings before their respective licensing boards.

Regulatory Compliance

We counsel providers in the development, implementation, review, and revision of their compliance programs, which are mandatory in New York under Social Services Law § 363-d and 18 NYCRR Part 521. We provide guidance on internal audit and monitoring, risk assessment, and corrective measures, such as self-disclosure, employee discipline, and enhanced training. We advise clients on privacy matters under federal and New York State laws and on issues related to fraud and abuse, including the physician self-referral law (Stark) and the anti-kickback statute.