Practice Areas & Industries: Pepper Hamilton LLP

Practice Group Overview

Health care providers and related businesses face a daunting legal environment. Health care is one of the most highly regulated industries in the nation, and those regulations are constantly changing and becoming more complex. For health care providers in particular, remaining profitable is increasingly difficult in times of shrinking reimbursements, growing litigation threats and soaring insurance premiums. Pepper Hamilton LLP's Health Care Services Practice Group focuses on helping health care clients overcome these challenges and meet their business goals.

Our clients include a wide range of providers, including hospitals, health care systems, physician groups, and nursing homes and other ancillary facilities. We also represent professional associations, health maintenance organizations and preferred provider organizations, as well as many businesses offering health care-related services .

Services Available

AREAS OF PRACTICE

Business Matters. We assist health care clients with mergers, acquisitions, dispositions, joint ventures and new business formation. We also counsel on business operations, including management and governance, all types of contract drafting and negotiation, physician and staff employment issues, and tax or tax exemption matters. Several of our lawyers counsel investment funds that invest in health care businesses, as well as the companies in the funds' portfolios.

Representative engagements in this area include:

• counseling on the creation of new hospitals and health systems
• advising on the growth of health systems and hospitals through mergers and acquisitions
• serving as outside general counsel to large health systems; services include counseling on regulatory matters, facility licensing/operations, managed care contracting and operations, Medicare payment, other reimbursement issues, physician credentialing and termination, all contracting issues, employment issues (including contracts for all executives and senior medical staff) and tax exemption matters
• counseling hospitals and health care systems in times of financial difficulty, including bankruptcy and reorganization
• assisting a number of hospitals, physicians and other providers in formulating and executing managed care business strategies, including the purchase and sale of physician practices, the formation and operation of ambulatory surgery centers, and the merger and acquisition of hospitals
• setting up independent physician associations, hospital-physician joint ventures, provider networks, multi-service organizations and ancillary service corporations
• advising hospitals and other health care entities on creating or joining group purchasing organizations
• counseling GPOs on relationships with vendors and other business and regulatory matters
• counseling health care entities on labor and employment issues, including entities with unionized workforces
• counseling the board of directors of a medical malpractice professional liability insurer regarding reorganization, capitalization, redemption, strategic partnering and fiduciary matters
• drafting and negotiating all technology transfer agreements on behalf of a major regional health care system during its multi-million-dollar acquisition of a university hospital system
• advising health care systems in connection with serious disputes with health care information systems vendors in connection with license and outsourcing issues, and negotiating win-win outcomes
• counseling numerous health care-related clients on partnership, corporate, and other tax and transactional aspects of venture financing and venture fund formation.

Regulatory Matters.We advise clients about compliance with a wide range of federal and state laws, including matters involving facility licensing and operations, practitioner licensing, managed care, Medicare issues, False Claims Act compliance, and anti-kickback and self-referral regulations. As described in more detail below, in addition to counseling about compliance, we represent clients in government investigations and litigation in these areas.

A significant part of our practice involves advising about compliance with the privacy and security requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Our lawyers (along with a client) literally wrote the book about HIPAA compliance - The Guide to Medical Privacy and HIPAA, published by Thompson Publishing Group.

Representative engagements include:

• advising health care systems regarding interpretation and implementation of HIPAA regulations, including development of required notices, forms, policies and procedures
• counseling many physician practice groups, hospitals, rehabilitation facilities and other clients about compliance with anti-kickback self-referral statutes and regulations in connection with marketing arrangements, physician recruitment, discounts and other matters
• providing fraud and anti-kickback advice in connection with the acquisition or sale of practices and joint venture formation
• counseling numerous health systems, hospitals, nursing homes, long-term care facilities, visiting nurse services and other businesses on facility licensing issues and managed care contracting/operations.

Litigation Matters.We represent health care clients in a wide range of disputes, ranging from government investigations of False Claims Act or Stark law violations to defending doctors, hospitals and other clients against medical malpractice claims. Much of our practice is aimed at helping clients prevent or reduce the risk of litigation. Should litigation occur, however, our group includes trial lawyers with experience at every level of the judicial system.

Representative engagements include:

• advising providers on response to investigations involving overbilling, including representing witnesses, responding to subpoenas, drafting corporate compliance programs and corporate integrity agreements, and procedures for implementation and monitoring compliance
• representing hospitals and health systems in litigation against managed care companies about payment issues, standard of care issues, utilization review procedures and other matters
• defending hospitals, doctors, nurses and other providers against medical malpractice claims involving death or catastrophic injury.