Nelson Hardiman represents a large number of hospitals and long term care facilities and is known for its innovative and creative ways in solving the issues affecting hospitals and long term care facilities.

The business and regulatory issues affecting hospitals and long term care facilities are both unique and complex. Providers must balance the needs of their patients with increased healthcare utilization and cost, decreased federal and state dollars to pay for healthcare costs, and increased government enforcement. This, in addition to the issues of managed care contracting and reimbursement disputes, professional and institutional licensure by accreditation bodies, and liability and staffing issues involving nursing and medical staff, all make for a challenging healthcare environment for hospitals and long term care facilities.

With federal and state governments dedicating more resources to enforcement actions and prosecuting fraud and abuse, hospitals and long term care facilities must be vigilant in maintaining regulatory compliance. What was formerly perceived by the government to be a simple billing error may now be viewed as fraud and abuse. In 2014, the federal government recovered $3.3 billion from healthcare providers in enforcement actions; and has recovered $7.70 for every dollar spent on health care-related fraud and abuse investigations in the last five years. The difference between a straightforward physician recruitment agreement or simple billing error, and a violation of the Stark/Anti-Kickback Statute or civil False Claims Act often depend upon competent legal representation.

Nelson Hardiman works closely with its hospital and long term care facility clients to guard against fraud and abuse through proactive compliance planning and is also qualified to advise on business operations matters and business transactions which could lead to healthcare fraud and abuse risks. Areas where Nelson Hardiman has provided counsel include:

  • Business Transactions
    • Physician recruitment
    • Practice acquisition
    • Health system contracts
    • Managed care contracts
    • Employment contracts
    • Joint ventures
  • Regulatory Defense
    • Licensing investigations and defense
    • DEA investigations and defense
    • Peer review and medical staff
    • Reimbursement audits and investigations by governmental payors
  • Compliance
    • Corporate compliance programs
    • Stark and Anti-Kickback Statute Compliance
    • Medicare and Medi-Cal compliance
    • Patient care issues
    • HIPAA and state patient data privacy and security requirements
    • Medical staff bylaws
    • Audit risk assessment
    • Employment law
    • Incident investigations
    • Tax exemption
    • Executive compensation
  • Litigation
    • Credentialing and peer review disputes
    • Licensure defense and appeals
    • Medicare and Medi-Cal appeals
    • Payor and reimbursement disputes
    • Overpayment appeals
    • False Claims Act / Qui tam whistle-blower litigation defense
    • Business and employment litigation
    • Lawsuit defense