Epstein Becker Green attorneys have assisted large and small physician group practices in not only surviving, but prospering, during an era of unprecedented change in the way that health care services are delivered and financed. We have extensive knowledge of the wide range of federal and state laws and regulations affecting the relationships among health care providers and the delivery and finance of health care goods and services.
Our attorneys add value by providing clear, concise legal reasoning and effective, practical solutions to complex legal problems. Indeed, Epstein Becker Green is the "one-stop shop" for physicians, providing a wide array of regulatory analysis, business advice, and transactional experience for some of the largest and most well-established physician practice groups in the country.
Services/Scope of Practice
- Providing advice and counsel on fraud and abuse and regulatory compliance arising under the Anti-Kickback Statute, the Stark Law, the False Claims Act, HIPAA, and other related federal and state laws and regulations
- Assisting in preparing for, responding to, and defending against health care fraud investigations and audits by the Department of Justice, the Department of Health and Human Services' Office of Inspector General, and other federal and state governmental authorities, including conducting internal reviews and investigations
- Structuring, analyzing, and negotiating managed care/payer arrangements, clinical integration transactions (involving network development, gainsharing, and accountable care organizations ("ACOs")), professional and administrative services agreements, and equipment leasing transactions
- Structuring and organizing joint ventures between physician groups and hospitals and among physician groups, including independent practice associations, ACOs, ambulatory surgery centers, diagnostic imaging facilities, and medical office buildings
- Advising on issues relating to the corporate practice of medicine, fee-splitting, and other state professional practice rules, regulations, and ethical standards
- Advising on the establishment and structure of multi-location, multi-specialty group practice and independent practice associations
- Drafting, analyzing, and negotiating leases, employment and shareholder agreements, independent contractor professional service agreements, practice management agreements, and various types of commercial contracts
- Assisting in selling or acquiring medical practices, as well as other physician group merger and consolidation transactions
- Litigating health care, antitrust, and employment litigation matters, primarily on behalf of physician group practices
- Counseling on a variety of human resources matters, including personnel policies and procedures, restrictive covenants (including non-solicitation, no-pirating, and confidentiality/non-disclosure covenants), physician compensation and incentives, and separation agreements
- Assisting with patient records and privacy and data security issues, including responding to subpoenas and HIPAA compliance
- Performing compliance effectiveness evaluations and advising on the development and implementation of corporate compliance programs, including drafting policies and procedures, training modules, and auditing/monitoring tools
- Advising on issues concerning federal, state, and commercial reimbursement, including challenges to regulatory actions and disputes under government and commercial payor contracts
- Counseling on peer review issues, medical staff appointments, and clinical privilege delineation at hospitals and other health care facilities
- Representing physicians in administrative proceedings, including hearings, before state licensing boards, and in appeals of managed care credentialing decisions
Representing a large, multispecialty, multi-location group medical practice in its formation, growth, and compliance; the firm provided advice and representation in all pertinent legal and regulatory areas related to employment, bank financing, revenue sharing, compliance, hospital relations, electronic health records, expansions in-state and across state lines, government investigations, and real estate matters.
Representing a radiology group practice in the comprehensive investigation of a multimillion dollar fraud and embezzlement scheme by the client's former office manager and third parties, which also involved a referral of the matter to the U.S. Attorney's office for criminal investigation and ultimately a successful criminal prosecution; our prosecution of the former employee and third parties in civil litigations in two jurisdictions resulted in the recovery of a substantial amount of the embezzled monies for the client.