Healthcare

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.

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

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.

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.

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.

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.

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.