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:
- Long Term Care and Senior Services
- Information Technology
- 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
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