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Physicians and Physician Groups

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The medical profession is changing. Physicians, non-physician practitioners, and provider-related businesses are faced with legal, financial, regulatory, and cultural changes. The consolidation of the health care profession industry, driven in large part by the Affordable Care Act and Medicare efforts to drive down the cost to federal programs, presents unique challenges to physicians. The relationships between providers, patients, and payers are shifting to accommodate these changes. We have broad experience in counseling physicians in establishing relationships in integrated settings.

At the same time, providers are faced with a variety of audits, refund demands, compliance reviews, and other enforcement activities of the regulatory agencies and third party payers. We regularly assist providers in responding to and defending such actions, as well as providing assistance in establishing compliance training and plans to avoid pitfalls in many practice areas governed by payer and regulatory authorities.

Services

  • Stark Act compliance
  • Anti-Kickback Statute compliance
  • False claims and billing matters
  • Physician practice formation
  • Provider network formation, accountable care organizations
  • Physician-hospital affiliation strategies, sales, and acquisitions, hospital employment of physicians
  • Mergers and acquisitions among providers
  • Joint ventures and ancillary businesses
  • Peer review hearings, staff privileges, and state licensure issues
  • Management of health care records (HIPAA)
  • Managed care and accountable care contracting
  • Clinical integration among providers
  • EMR issues, health IT management and liability
  • Telemedicine and technology issues among providers
  • Payer relations, audits, and appeals
  • Risk retention group formation and representation
  • Billing, coding, and coverage issues
  • Intellectual Property protection, copyright, and patent prosecution
  • Federal and state government relations
  • Antitrust issues in contracting and business activities
  • Litigation, mediation and arbitration