Experience

Represents physicians, dentists, podiatrists, and other clinical professionals in a wide range of commercial arrangements, including mergers/acquisitions, practice “roll-ups” (including sales to private equity firms), affiliations, recruitment arrangements, and other types of clinical integration transactions in numerous medical and surgical specialties.
Advises digital health entrepreneurs on fundamental regulatory and business structural issues.
Advises early-stage physician practice management companies in developing and implementing practice acquisition strategies and related matters for the new services entity, including all related transaction documents (i.e., asset purchase agreements, physician employment agreements, management services agreements, etc.)
Assists an extensive continuing care retirement community chain with unique regulatory requirements across multiple states.
Drafts and negotiates complex commercial contracts among and between healthcare providers and pharmaceutical and medical device manufacturers.
Drafts and negotiates a wide range of healthcare-related contracts, including physician employment agreements, buy/sell agreements, operating agreements, vendor contracts, managed care agreements, and joint venture agreements.
Negotiated high-value contracts between healthcare providers, insurers, and suppliers, ensuring compliance with all regulatory requirements.

Provides advice and counsel to hospitals, physicians, and other providers regarding the interpretation of the HIPAA and HITECH regulations.
Coordinates data breach responses, including those involving protected health information subject to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and personally identifiable information subject to state breach law.
Represents medical practices in handling ransomware attacks, including engaging forensic experts and analyzing HIPAA and state breach law obligations.

Serves as lead counsel in reimbursement disputes at all levels of the Medicare/Medicaid programs, including redeterminations, reconsiderations, and hearings in front of administrative law judges.
Represents healthcare providers in disputes with commercial payors in reimbursement disputes relating to alleged improper coding, use of modifiers, medical necessity, and site of service.
Serves as lead counsel in cases involving more serious allegations, e.g., violations of the False Claims Act, Stark Act, or the Anti-Kickback Statute, to reach settlements that minimize the risk and cost of fines and criminal liability.
Works closely with clients to review billing practices, identify and remedy coding issues, and analyze payor policies and procedures implemented to minimize payment reductions.
Conducting internal investigations to identify and correct billing inconsistencies and reduce the likelihood of reimbursement denials.

Representing healthcare providers in payor audits, including Medicare MAC and HCPIC audit appeals through the Administrative Law Judge level.
Advises healthcare organizations on regulatory compliance matters, including Medicare and Medicaid reimbursement issues, fraud and abuse laws, and patient privacy regulations.
Conducted numerous compliance audits and internal investigations to identify and mitigate legal risks with respect to “core” healthcare laws and regulations, including Anti-Kickback, Stark, HIPAA, and the Sunshine Act.
Represents healthcare providers in connection with voluntary disclosures in connection withthe U.S. Department of Health and Human Services – OIG Voluntary Self-Disclosure Protocol and the CMS Physician Self-Referral Law Voluntary Disclosure Protocol.