Healthcare Industry

Overview

At a time of almost certain change within the healthcare industry, members of our health industry and health policy team are informed, steady and responsive. We have the national presence and depth to help clients strategically navigate these challenges so they can manage and respond nimbly to change.

Our attorneys have served within hospitals and health centers, research centers, long-term care providers, health maintenance organizations, third-party payors and in Congress, and we share an experienced perspective on challenges facing healthcare providers, including a wide range of matters outlined further below.

Our clients are varied and diverse across the healthcare industry spectrum, including:

  • Academic medical centers and teaching hospitals
  • Children’s and adult acute care hospitals
  • Home health, hospice and niche providers
  • Healthcare systems, including integrated providers such as physician groups, ACOs, provider-sponsored HMOs and ClNs
  • Long-term care providers
  • Pharmaceutical companies
  • Physician practices – large and small
  • Managed care and third-party payors
  • Suppliers
  • DME providers
  • Healthcare advocacy associations
  • Private equity groups investing in healthcare entities
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We also leverage BakerHostetler’s more than 940 attorneys in 14 offices nationwide to counsel health industry clients in multiple areas of law, including employment and labor, litigation, white collar and business practices, tax, corporate governance, government policy and intellectual property.

We routinely address issues of concern and relevance to our health industry clients including:

  • Antitrust 
  • Certificate of Need (CON) Laws
  • Clinical Research Compliance
  • Licensure, Survey and Certification
  • Cybersecurity and Data Privacy
  • Data Breach
  • False Claims Act
  • Fraud and Abuse Laws
  • Government Investigations and Enforcement
  • Healthcare Policy
  • Healthcare Transactions/Joint Ventures and Affiliations
  • Health Plans, Insurance and TPAs
  • HIPAA
  • Long-term Care Providers
  • Managed Care
  • Pharmacy
  • Private Equity and Venture Capital Transactions
  • Regulatory
  • Medicare/Medicaid Billing, Coding and Reimbursement
  • Stark Law
  • Tax
  • Telemedicine
  • Third-Party Payor Negotiations

We hold a unique, national presence in the academic medical center, children’s hospital and data breach sectors. We have counseled many of our clients for decades, including some of the nation’s leading hospital systems and medical facilities. They trust us to consider particular problems within the context of their broad business needs and to provide creative solutions.

Our services

With the Trump administration promising a rollback of the Affordable Care Act and significant changes to the manner in which Medicare and Medicaid may be funded, our Healthcare Public Policy team is closely monitoring emerging policies and advancing our clients’ interests on Capitol Hill with relevant healthcare agencies and with the administration. We routinely assist clients in developing legislative and regulatory proposals and legislative language to help clients effectively communicate, advocate on their behalf, develop strategies for advancing their goals, and manage the adverse impacts that healthcare legislation and regulation may have on their organizations. We also work well with trade associations in partnering to advance their message.

Clients look to our attorneys to help them form new entities and ventures, respond to data breaches and other privacy matters, identify and advise on specific fraud and abuse risk areas, defend against enforcement investigations and proceedings, and develop and execute legislative and regulatory strategies, among many other tasks.

We help hospitals, health systems, academic medical centers and other medical providers grow through acquisitions of facilities, facility leases, financings, management contracts, affiliate agreements and the creation of new relationships with relevant partners, and we counsel them on a full range of operational matters. We work with physician groups of all sizes to structure joint ventures and other relationships between and among physicians, physician groups, hospitals, special healthcare service providers and others in the industry.

Our Healthcare Privacy team continues to be on the cutting edge of HIPAA and has provided timely and discrete advice to clients through more than 500 data breach responses, including responses to the three largest U.S. healthcare data breaches ever reported. We counsel healthcare providers and other covered entities on HIPAA and state privacy law compliance, breach response, crisis management, and regulatory investigations and audits. In this period of aggressive regulatory enforcement, our enforcement and compliance attorneys work to keep our clients out of the headlines by proactively identifying and providing advice on their specific risk areas, including those related to the Anti-Kickback and Stark laws, the False Claims Act, HIPAA and HITECH, EMTALA, licensing and certification matters, OSHA, and a wide range of coding and billing issues. Our team has substantial experience defending providers in all facets of audits and proceedings initiated by fiscal intermediaries, program integrity contractors, and federal and state governmental authorities, among many others.

We have specialized healthcare reimbursement experience in Medicare and Medicaid program payment matters, having handled major reimbursement disputes in both Medicare and Medicaid graduate medical education (GME) and disproportionate share hospital (DSH) issues. We assist with a wide range of Medicare and Medicaid appeals and audits. We also represent hospitals and physicians in managed care negotiations, contracting, and payment disputes and are experienced in the Medicare and Medicaid managed care law and regulations. We work to manage enrollment, changes in ownership and certification issues, licensing, and Joint Commission responses and corrective action issues. We have lawyers skilled in cost report reimbursement, appeals, and financial payment concerns arising out of state and federal government payors, as well as commercial payors. 

Select Experience

  • Served as team leader in a major integration of an academic medical center's faculty practice plans, including the transition of 450 physicians and more than 20 separate non-profit and for-profit entities. Established a plan for a new entity to function as the sole multi-specialty practice plan. Resolved governance, organizational, tax and regulatory issues.
  • Counseled a regional healthcare system in the wake of improper employee access to over 100,000 patients' records. Coordinated the internal investigation and led the response on several fronts, including crisis management, notification of affected patients, resolution of patient complaints, regulatory investigations and defense in a class action alleging failure to safeguard confidential personal information and notify class members of the incident in a timely manner. We combined our healthcare, privacy and class action litigation experience for a full-service strategic defense of the matter.
  • We provide the Children’s Hospital Association—which includes more than 200 children’s hospitals in this country—with national Medicaid policy advice. We helped to develop a particular program for children with chronic and complex conditions, develop a risk-based payment mechanism in Medicaid tied to the creation of a pediatric medical home and analyzed Medicaid claims data and whether a coordinated care model can provide scoreable savings for Congress. We are directly involved in both the continued development of the policy, as well as with strategic advocacy in Congress, with CMS and the administration, identifying champions, preparing and supporting the policy, developing the legislative language and providing substantive legal and policy support for the concept.
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Professionals

Name Title Office Email
Associate Atlanta
Partner Columbus
Partner Orlando
Partner Washington, D.C.
Partner Atlanta
Counsel Atlanta
Partner Washington, D.C.
Partner Los Angeles
Associate Atlanta
Partner Atlanta
Partner Houston
Of Counsel Cleveland
Partner Orlando
Associate Houston
Partner New York
Partner Atlanta
Partner Atlanta
Associate Atlanta
Counsel Atlanta
Partner Atlanta
Partner Cleveland
Counsel Atlanta
Associate Houston
Partner Columbus
Partner Columbus
Partner New York
Associate Atlanta
Of Counsel Washington, D.C.
Partner Atlanta
Partner Los Angeles
Associate Atlanta
Counsel Atlanta
Partner Orlando
Associate Atlanta
Partner Columbus
Senior Advisor Columbus
Partner Cleveland
Associate Washington, D.C.
Partner Cleveland
Partner Washington, D.C.
Senior Advisor Washington, D.C.
Partner Atlanta
Partner Los Angeles
Partner Cincinnati
Associate Washington, D.C.
Counsel Atlanta
Partner Cleveland
Partner New York
Associate Atlanta
Partner Atlanta
Partner Costa Mesa
Partner Orlando
Partner Los Angeles
Partner Cleveland
Partner Atlanta
Regulatory Analyst Atlanta
Partner Los Angeles
Partner Atlanta
Partner Cleveland
Partner Cincinnati
Associate Atlanta
Partner Houston
Associate Atlanta
Associate Seattle
Associate Atlanta
Associate Atlanta
Partner Philadelphia
Of Counsel Washington, D.C.
Partner Atlanta
Partner Los Angeles
Partner Washington, D.C.
Partner Atlanta
Counsel Atlanta
Partner Columbus
Partner Houston
Partner Orlando
Partner Houston
Partner Washington, D.C.
Partner Washington, D.C.
Partner Cleveland
Counsel Cincinnati
Senior Advisor Washington, D.C.
Partner New York
Partner Columbus
Partner Cleveland
Regulatory Analyst Atlanta
Of Counsel Los Angeles
Associate Atlanta
Partner Columbus
Partner Houston
Partner Atlanta
Counsel Denver

Experience

  • Served as team leader in a major integration of an academic medical center's faculty practice plans, including the transition of 450 physicians and more than 20 separate non-profit and for-profit entities. Established a plan for a new entity to function as the sole multi-specialty practice plan. Resolved governance, organizational, tax and regulatory issues.
  • Counseled a regional healthcare system in the wake of improper employee access to over 100,000 patients' records. Coordinated the internal investigation and led the response on several fronts, including crisis management, notification of affected patients, resolution of patient complaints, regulatory investigations and defense in a class action alleging failure to safeguard confidential personal information and notify class members of the incident in a timely manner. We combined our healthcare, privacy and class action litigation experience for a full-service strategic defense of the matter.
  • We provide the Children’s Hospital Association—which includes more than 200 children’s hospitals in this country—with national Medicaid policy advice. We helped to develop a particular program for children with chronic and complex conditions, develop a risk-based payment mechanism in Medicaid tied to the creation of a pediatric medical home and analyzed Medicaid claims data and whether a coordinated care model can provide scoreable savings for Congress. We are directly involved in both the continued development of the policy, as well as with strategic advocacy in Congress, with CMS and the administration, identifying champions, preparing and supporting the policy, developing the legislative language and providing substantive legal and policy support for the concept.
  • Representing major children’s hospitals in Texas and Washington state in challenging a CMS interpretation of the DSH hospital specific limit (HSL) reimbursement relative to the calculation of Medicaid shortfall. Similar determinations affect all seven freestanding children’s hospitals in Texas for a total potential loss of as much as $70 million in Medicaid program reimbursement and approximately $15 million to Washington children’s hospitals. Representation involves meeting with CMS officials, convincing the State of Texas to support a compromise approach, developing federal legislative bill language and support of the Texas and Washington delegation and filing a temporary restraining order in state court.

Recognition

  • Chambers USA: Healthcare
    • Georgia (2015 to 2017)
    • Ohio (2011 to 2017)
    • Texas (2009 to 2017)
    • Recognized Practitioner in Florida (2016, 2017)
    • Recognized Practitioner Nationwide (2017)
  • Recognized as one of the top law firms for client service, we were named to the 2018 BTI Client Service 30 for the fourth consecutive year.
  • U.S. News - Best Lawyers “Best Law Firms” (2016)
    • Health Care Law
      • National Tier 1
      • Metro Atlanta, Tier 1
      • Metro Cincinnati, Tier 2
      • Metro Cleveland, Tier 2
      • Metro Columbus, Tier 2
      • Metro Houston, Tier 1
  • The Best Lawyers in America© (2016)
    • 10 lawyers named in Health Care Law
  • Named a national leader among law firms serving the healthcare industry by the BTI Client Relationship Scorecard 2014: Ranking Law Firm Client Relationships

News

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Press Releases

Publications

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In The Blogs

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Health Law Update
CMS aims to decrease burdens and increase innovation in Medicare parts C and D with new April 2018 guidance
April 20, 2018
In regulations published on April 16, 2018, the Centers for Medicare & Medicaid Services (CMS) issued two new documents containing guidance primarily on the Medicare Advantage (MA) program and on the Medicare prescription drug benefit...
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Health Law Update
Capitol Hill Healthcare Update
April 16, 2018
HOUSE PANEL TO QUESTION GOTTLIEB ON FDA BUDGET Food and Drug Administration (FDA) Commissioner Scott Gottlieb will testify Tuesday before a House appropriations subcommittee on his agency’s fiscal 2019 budget – which includes the largest...
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Health Law Update
Capitol Hill Healthcare Update
April 9, 2018
CONGRESS RECONVENES, WITH A FOCUS ON OPIOIDS Lawmakers return today to Capitol Hill after a two-week recess, and multiple committees in both the House and Senate are poised to examine the opioid crisis and potential legislative solutions...
Read More ->
Health Law Update
Capitol Hill Healthcare Update
March 19, 2018
CONGRESS WORKS TO PASS BUDGET BEFORE FRIDAY’S SHUTDOWN DEADLINE House leaders are pushing to schedule a vote this week on a $1.3 trillion budget agreement that would give the Senate enough time to pass it before a Friday deadline when...
Read More ->
Health Law Update
Capitol Hill Healthcare Update
March 12, 2018
HOUSE VOTE SET FOR UPDATED ‘RIGHT-TO-TRY’ LEGISLATION The House will vote Tuesday on updated but still controversial legislation that would give terminally ill patients wider access to prescription drugs that haven’t won approval by the...
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Healthcare Highlights: 25th Annual Legislative Seminar