Practice Areas & Industries: Duane Morris LLP

 





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Practice/Industry Group Overview

Today's healthcare providers focus on cost-effective ways to manage and grow their businesses. At Duane Morris, more than 35 full-time healthcare lawyers understand these market demands and assist healthcare providers to create business and legal value in all types of situations - transactional, regulatory and litigation.

We tailor our services to specific segments of the healthcare industry, including:

  • Hospitals
  • Physicians
  • Long Term Care and Senior Services
  • Information Technology
  • Litigation
  • mHealth, Telemedicine and Health Information Technology

With more than 25 years serving the healthcare industry, Duane Morris has one of the largest and most respected health law practice groups among U.S. law firms. With offices in major markets in the United States and offices in London, Singapore and Vietnam, we counsel leading organizations in every major sector of the healthcare industry on regulatory, business transactions and litigation matters.

Innovative Healthcare Law

We develop innovative and creative ways to help healthcare clients increase their profitability and protect their assets. From representing hospitals in disputes with payors to receive adequate payment for their services to creating computer-assisted gap assessment tools for compliance, Duane Morris has developed a reputation as an innovative problem solver.

In this respect, we work differently from other law firm healthcare practices - our culture encourages teamwork and professional leadership as well as innovation. Many of our healthcare lawyers have direct experience working in the healthcare industry, giving us a firsthand perspective on what's needed to succeed and how best to accomplish transactions, navigate regulatory frameworks and manage litigation-related situations.

National Practice/Regional Focus

While we have a prominent national practice, we also focus on the regional issues that matter most to our clients. Whether the client is an academic medical center, community hospital, physician practice, nursing home or an assisted living/senior housing provider, we can serve the full spectrum of their needs - from local and regional issues to matters with national and even international implications.

Some of our areas of healthcare concentration include:

  • Insurance Reimbursement/Payor Contracting
  • Physician-Hospital Transactions
  • Sale/Acquisition of Facility Assets
  • Regulatory Compliance
  • Licensure and Credentialing
  • Legislative and Public Policy Issues, including lobbying
  • Long Term Care and Senior Services
  • Home Healthcare
  • Governance Issues
  • Healthcare Fraud and Abuse
  • Healthcare Litigation
  • Services for Physicians
  • Services for Hospitals
  • mHealth, Telemedicine and Health Information Technology

Representative Engagements

Stark and Anti-Kickback Regulations - Our attorneys regularly advise on Stark and anti-kickback issues and have developed unique ways for physicians to share in ancillary revenue in compliance with federal and state regulations.

Multimillion-Dollar Settlement of Disputed Claims by Physicians and Hospitals - Using an innovative approach and a proprietary audit tool, our lawyers brought a lawsuit that resulted in a speedy settlement and a multimillion-dollar payment to more than 400 physicians. The lawsuit also served as a mechanism to audit future payment patterns and to ensure that the client will not have to file similar claims in the future.

Innovative Approaches to Hospital Reimbursement - As a leader in representing hospitals in their disputes with payors to obtain adequate payment for their services, our lawyers brought a lawsuit on behalf of a community hospital under several unique theories attacking the insufficient payments of a local Blue Cross plan. The case gained national attention.

Self Insurance Options for Hospitals - Utilizing its understanding of malpractice insurance, Duane Morris has designed self-insurance trusts and off-shore captive insurers to offer insurance coverage to hospitals unable to find affordable malpractice coverage.

For a complete list of representative services and engagements, contact any Duane Morris office and ask to speak with a healthcare lawyer.

Physician Services Group

Business Issues: Physicians face a number of business issues in the current healthcare environment, including: decreasing governmental and private rates of reimbursement, managed care contracting and contract enforcement, competition for delivery of ancillary services, physician-hospital joint ventures, practice expansion opportunities, incentive compensation arrangements, buy-in and buy-out arrangements, noncompetition agreements, exclusive contracts, affordable medical malpractice insurance, billing, coding and claims denial problems and staff privilege issues.

Duane Morris Capabilities: Our healthcare attorneys have direct and extensive experience in addressing the myriad of business issues facing physicians. Our attorneys have wide experience in negotiating and enforcing managed care contracts, including litigation against managed care companies. We have developed procedures to achieve legally compliant ancillary service and other practice expansion opportunities, including unique physician-hospital joint ventures.

Our attorneys understand the business aspects of physician practices, including preparation of physician employment agreements, compensation plans, buy-in and buy-out issues and non-competition provisions. A subsidiary of Duane Morris employs medical industry professionals to provide cutting-edge solutions to billing, coding and claims denial issues.

Services for Hospitals

Business Issues: The business issues hospitals face are extraordinarily complex. Administrators must balance the needs of patients and staff with the growing uncertainty that results from the increased demand for medical care and a decrease in the amount of federal and state dollars to pay for it. Hospitals are dependent on Medicare and Medicaid financing, which leads to disputes involving reimbursement for services rendered and interpretation of state and federal regulations. The negotiation and enforcement of managed care contracts demand knowledge of the cost of services, as well as state and federal law governing insurance, managed care and healthcare contracting. Professional and institutional licensure and accreditation bodies are becoming increasingly vigilant, due to reports questioning the quality of care rendered in academic and community hospitals. Liability and staffing issues predominate as hospitals are faced with a shortage of nursing and medical staff, due to the high cost of malpractice insurance and threats of collective bargaining.

Employment and staff credentialing issues remain important to hospitals striving for a high level of professionalism while attempting to decrease professional liability. Governance at healthcare facilities is under increased scrutiny, leading to concern about compliance with federal and state common law, statutory and regulatory mandates related to fiduciary obligations of board members, senior management and highly compensated physicians. Concerns about fraud and abuse, kickbacks and Stark law violations dominate the thinking of hospital financial managers as institutions seek to expand their services through joint ventures, mergers and acquisitions. HIPAA regulations and homeland security issues are requiring hospitals to implement major changes in policies and procedures throughout their organizations.

Duane Morris Capabilities: Our healthcare lawyers are experienced in handling these types of diverse issues. For example, several of our lawyers have served as in-house general counsel at major teaching hospitals and major trade associations. Others have extensive experience counseling healthcare systems, community and specialty hospitals. We also serve as general counsel to a number of hospitals and health systems, and are on the preferred counsel list for others. The tax and corporate lawyers in our healthcare group have represented hospitals in transactions of all types. These include hospital restructurings and expansions, conversions, acquisitions, development of hospital-physician joint ventures, ambulatory surgery, radiation oncology, cardiology and lithotripsy centers.

We represent hospital clients in administrative hearings and litigation involving managed care, employment and commercial disputes, reimbursement matters, medical staff relationships, insurance and liability questions of all kinds. We understand hospital finance, cost accounting and reimbursement issues and have developed creative solutions to difficult problems.

Our lawyers represent the Hospital & Healthsystem Association of Pennsylvania and work closely with hospital associations in other states. We also work with a number of hospitals in academic medical centers and are well versed in the issues faced by academic hospitals and faculty practice plans. We have represented hospitals in connection with research studies and clinical trials. Attorneys and medical professionals, employed by a Duane Morris subsidiary, work with hospitals to provide innovative solutions to problems related to billing, coding and denial of claims.

Long Term Care and Senior Services

Business Issues: From development of new facilities to general operational matters, long term care and senior services providers need legal assistance and counsel in many aspects of their business. Our practice in this area is designed to meet these providers’ specific needs and relies on significant involvement and understanding of the industry and the government agencies that regulate it. Our approach to representation of long term care and senior services providers involves a coordinated effort among lawyers with experience in relevant subject matters, including health law, corporate law, tax-exempt law, employment law, information technology law, real estate law and litigation.

Duane Morris Capabilities: Our Long Term Care and Senior Services practice is both transactional and regulatory. We represent virtually all segments of the long term care and senior services industry, including skilled nursing and rehabilitation facilities, continuing care retirement communities (CCRCs), assisted living and seniors housing communities, home care agencies, hospices and adult day healthcare providers (ADHCs). Our clients range from the smallest single-facility providers to some of the largest providers of long term care, assisted living and senior services in the U.S. We have a broad range of experience and knowledge in the long term care industry including the following:

  • Acquisitions and Sales
  • Development and Financing of New Facilities
  • Corporate Compliance, Risk Management, and Fraud and Abuse Counseling
  • Government Audit and Enforcement Matters
  • Administrative Litigation
  • Reimbursement Matters
  • Certificate of Need, Licensing and Change of Ownership

 

Services Available

 
Group Presentations
  Duane Morris Special Counsel Michael E. Clark to Present at the 2015 Physicians Legal Issues Conference, Chicago, June 10, 2015
Simplifying the Complexities of Compliance, Wheeling, IL, June 3, 2015
Duane Morris Partner Greg Brodek to Speak at Texas Unencumbered #bizPT Conference, Irving, TX, May 29, 2015
Duane Morris Partner Lisa Clark will be a Panelist at the Drexel University Cybersecurity Institute Symposium Healthcare Data Security Part II, Philadelphia, February 25, 2015
Duane Morris Partner Mark Silberman to Present at AHLA's Long Term Care and the Law Conference, New Orleans, February 24, 2015
See more...
 
Past Seminar Materials
  Duane Morris Partner Patricia Hofstra to Speak on "Retail Clinics in Healthcare: Overcoming Complex Legal Challenges", March 11, 2015
 
 
Articles Authored by Lawyers at this office:

CMS Updates 5 Star Ratings System for Nursing Homes with New Measures
Ari J. Markenson, April 07, 2015
As of February 20, 2015, the Centers for Medicare & Medicaid Services (CMS) has revised its 5 Star Rating System for nursing homes. The changes to the system involve adding two new nursing home quality measures for antipsychotic use into the Quality Measure Rating, Increasing the number of...

Lawyer in Vietnam Oliver Massmann Pharmaceutical Market
Oliver Massmann, March 30, 2015
Vietnam’s healthcare system is currently in general on the move due to the economic growth and the rapid development.

OIG - Medicare Hospices Have Financial Incentives to Provide Care in Assisted Living Facilities
Ari J. Markenson, March 30, 2015
On January 14, 2015, the U.S. DHHS Inspector General’s Office (the “OIG”) released a report (OEI-02-14-00070) entitled “Medicare Hospices Have Financial Incentives to Provide Care in Assisted Living Facilities.”

CMS Advises That Payment Codes on Home Health Claims Will Be Matched Against OASIS
Ari J. Markenson, March 25, 2015
CMS recently issued Transmittal SE1504 entitled “Payment Codes on Home Health Claims Will Be Matched Against Patient Assessments”.

Civil RICO Actions on the Rise to Combat Healthcare Insurance Fraud
James J. Ferrelli, March 25, 2015
Over the past several years, insurance carriers have aggressively pursued civil suits against doctors and other medical providers in an effort to fight healthcare insurance fraud. Besides theories of liability based upon common law claims such as fraud and unjust enrichment, insurers have more...

Consultants’ Communications Privileged from Discovery
Philip H. Lebowitz, March 25, 2015
In healthcare, companies often hire consultants to review billing and coding, privacy and security and a host of other technical issues that regular staff does not have the time or expertise to pursue. A recent discovery ruling in federal court in the Eastern District of Pennsylvania holds that...

HHS Moves to Limit In-Office Ancillary Services Exception
Matthew C. Jones, March 19, 2015
The Department of Health and Human Services (“HHS”) is once again targeting the In-Office Ancillary Services Exception (“IOASE”) to the federal Stark Law, in an attempt to produce cost savings in the U.S. healthcare system. The IOASE provides a limited exception to the Stark...

Health System Integration and Antitrust Laws on Collision Course
Philip H. Lebowitz, March 18, 2015
Health systems attempting to fulfill the mandate of integrating hospitals and physicians may find themselves accused of going too far. Although the Affordable Care Act, shared savings, gainsharing and other alternative payment methodologies have made integration of physicians, hospitals and other...

New Jersey State Bar Committee to Review RPC 1.2(d) and Issues Pertaining to Medical Marijuana
James J. Ferrelli, March 18, 2015
The New Jersey State Bar Association (“NJSBA”) has established an ad hoc committee to review the ethical issues raised under New Jersey Rule of Professional Conduct 1.2(d) (which prohibits a lawyer from counseling or assisting a client in conduct that the lawyer knows is illegal or...

Virtual Credit Card Payments
Patricia S. Hofstra, March 18, 2015
On January 30, 2015, several healthcare organizations sent a group letter to CMS protesting the use of virtual credit cards by health plans to pay providers. In a virtual credit card payment (a nonstandard type of electronic funds transfer EFT), a health plan or its payment vendor issues single-use...

ACOs are More Important Than Ever for LTC Facilities
Amy E. McCracken, March 13, 2015
On January 26, 2015, the United States Department of Health & Human Services (HHS) announced its timeline for shifting Medicare reimbursements from volume-based criteria to value-based criteria. HHS has adopted a framework that categorizes health care payments according to how providers receive...

Antipsychotic Drug Use Can Lower Nursing Home's Five-Star Rating
Amy E. McCracken, March 13, 2015
The Centers for Medicare & Medicaid Services (CMS) is continuing its efforts to reduce the national prevalence of antipsychotic drug use in long-stay nursing home residents. Its initial goal of a 15.1% reduction in antipsychotic drug use was met, so CMS now seeks to reduce antipsychotic drugs...

Fees and Costs Awarded to False Claims Act Defendant
Seth A. Goldberg, March 13, 2015
A recent decision in the U.S. District Court for the Southern District of New York provides fair warning to qui tam relators who assert erroneous claims under the False Claims Act ("FCA") that they could be hit with legal fees and expenses pursuant to 31 U.S.C. § 3730, which permits...

Health Care Workers May Think Twice Before Becoming a Relator
Amy E. McCracken, March 13, 2015
The Federal False Claims Act (and many similar state false claims acts) allow an individual-called a "relator"-to file a lawsuit on behalf of the United States Government. If successful, the relator stands to collect a portion of the amount collected. Since the False Claims Act provides...

Mayo Lawsuit Against Former Exec Raises Numerous Health Care and Business Litigation Issues
Elinor H. Murarova, March 13, 2015
A recent settlement between Mayo Collaborative Services d/b/a Mayo Medical Laboratories ("MML") and Mayo Clinic (together with MML, "Mayo") and a former Mayo executive, Dr. Franklin Cockerill, reveals the potential legal issues that may arise when health care executives seek new...

New CMS Payment Policy Will Negatively impact Healthcare Investors
C. Mitchell Goldman, March 13, 2015
I have been concerned about the difficulty of projecting revenue and determining valuations for new and existing healthcare companies based on risk based reimbursement models. My fears have not been allayed. Rather, they have been confirmed.

Real Estate Tax Exemption Issue Muddied Again
Philip H. Lebowitz, March 13, 2015
On December 23, 2014, the Commonwealth Court of Pennsylvania logged another frustrating mile down the confused and confusing road of property tax exemption for purely public charities. In Fayette Resources, Inc. v. Fayette County Board of Assessment Appeals, the Court overturned a lower court...

Top Three Problems with Text Messaging in Health Care Settings
Amy E. McCracken, March 13, 2015
1. Since most text messaging is not a secure form of communication, it raises HIPAA concerns if any protected health information is included in the text message. There is the possibility of a data breach in the transmission of the text message, as well as in the event of a lost or stolen phone.

FDA Issues Guidance on Registration, Fees and Reporting Requirements for Drug Compounding Outsourcing Facilities
, February 26, 2015
On November 21, 2014, the U.S. Food and Drug Administration (FDA) announced the release of three new guidance documents related to drug compounding outsourcing facilities. These documents include:

7th Circuit Clarifies FCA Fraud Standard
Philip H. Lebowitz, January 23, 2015
In an opinion openly skeptical of a relator’s knowledge, the 7th Circuit Court of Appeals recently affirmed the dismissal of False Claims Act claims against a Chicago pharmacy brought by a former employee of the pharmacy. The principal claims in the case, nadyor v. Ukrainian Village Pharmacy,...

CMS Bringing Star Ratings to Home Health
Ari J. Markenson, January 23, 2015
The Centers for Medicare and Medicaid Services (“CMS”) issued a fact sheet on December 11th, 2014, discussing its intention to issue star ratings for Medicare certified home health agencies. The star ratings would be live in 2015.

Clinical Trial Sponsors Can Be Liable For Inadequate Consent Forms
Philip H. Lebowitz, January 23, 2015
Physicians acting as investigators for a clinical trial testing a new therapy are required to present to each patient or study subject a consent form, indicating that the patient understands the risks, benefits and alternatives of participating in the trial and voluntarily elects to do so. Federal...

The IMPACT ACT of 2014 - New Enforcement and Oversight for Hospice Providers
Ari J. Markenson, January 23, 2015
The IMPACT Act of 2014 (“IMPACT”) was signed into law on October 6, 2014. It includes two significant enforcement and oversight changes for Medicare hospice providers among other post-acute care policy changes.

OIG 2015 Work Plan - Hospice
Ari J. Markenson, January 22, 2015
Recently, the Department of Health and Human Services Office of the Inspector General (the OIG) released its work plan for 2015. The work plan provides stakeholders with a road map to the OIG’s activities in the coming year as they relate to its enforcement priorities and issues it will...

OIG 2015 Work Plan - Home Health
Ari J. Markenson, January 02, 2015
Recently, the Department of Health and Human Services Office of the Inspector General (the OIG) released its work plan for 2015. The work plan provides stakeholders with a road map to the OIG’s activities in the coming year as they relate to its enforcement priorities and issues it will...

Responding to Subpoena for Medical Records May Create Liability for Healthcare Providers Under State Law Negligence Claims
Seth A. Goldberg,Philip H. Lebowitz, December 10, 2014
Healthcare providers receiving a subpoena for patient medical records may want to think twice before complying with the subpoena and producing the records. A recent Connecticut case, Byrne v. Avery Center for Obstetrics and Gynecology, P.C. ("Byrne"), arose when the defendant gynecology...

CMS Extends Period of Exemption for Hospices Affected by Nursing Shortage
Ari J. Markenson, November 17, 2014
On October 3, 2014, CMS issued S&C: 12-43-Hospice entitled “Impact of Nursing Shortage on Hospice Care”.

FDA's Final Guidance on Determination of Five-Year NCE Exclusivity for Certain Fixed-Combination Drug Products Under Federal FDCA
Carolyn A. Alenci,Frederick R. Ball, November 17, 2014
The U.S. Food and Drug Administration (FDA) recently published its final Guidance for Industry detailing circumstances under which a fixed-combination drug product (FCD) may be entitled to five-year new chemical entity (NCE) exclusivity.

OIG 2015 Work Plan - Skilled Nursing Facilities
Ari J. Markenson, November 17, 2014
Recently, the Department of Health and Human Services Office of the Inspector General (the OIG) released its work plan for 2015. The work plan provides stakeholders with a road map to the OIG’s activities in the coming year as they relate to its enforcement priorities and issues it will...