Nelson Hardiman accomplishes the goals of primary care physicians facing new challenges from the evolving medical, technological and regulatory landscape. The resurgence of managed care, accelerated by the Affordable Care Act (ACA) drives the increased migration of physicians out of private practice into managed-care, hospital-affiliated independent physician associations (IPAs), creating new operational and alignment issues for physicians and setting the stage for new models of delivering healthcare services such as concierge practices and telemedicine.
As primary care physicians service a growing patient population and explore new healthcare delivery models, we help navigate complex legal issues such as the Anti-kickback and Stark laws, HIPAA privacy compliance, and California’s ban on the corporate practice of medicine. Whether you want to set up a compliant IPA business model, negotiate a managed care contract, or are facing exclusion from a health plan’s “narrow network,” we represent primary care physicians in business matters and high-stakes litigation where it counts. Whatever the challenge, Nelson Hardiman has the experience and resources to resolve the problems facing our IPA clients.
Our Work Includes:
- Corporate Practice of Medicine Advised on corporate practice of medicine requirements in structuring business and financial relationships between physicians, entrepreneurs, and investors.
- Employment Drafted employment contracts, employee handbooks and independent contractor agreements for several physician practices.
- HIPAA and State Patient Data Privacy and Security Requirements Advised a national physician specialty organization in developing a HIPAA-compliant patient data registry providing outcomes measurement and quality improvement.
- Medicare Overpayment Achieved a $3.1 million (from $3.2 million to $75,000) reduction in a Medicare over-payment determination against a physician group in a contested hearing against recovery audit contractor.
- Merger & Acquisition Represented a large dermatology practice, including a dermatopathology lab, in a $15 million acquisition. The complex transaction required a complicated series of financial tranches structured to meet tax and regulatory requirements.
- Partnership Dispute Successfully mediated a partnership dispute involving an orthopedic practice of physicians and chiropractors.
- Stark and Anti-Kickback Statute Advised primary care physician groups on compliance issues.
- Telehealth Compliance Advised a national telehealth provider on multi-state licensing, compliance, reimbursement, patient privacy, and standard of care issues.
- Unfair Competition Obtained dismissal on a motion for summary judgment involving medical partnership that falsely accused a competing surgery center of stealing physicians and providing unlawful payments in return.