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Healthcare Industry

Overview

At a time of rapid change and tremendous uncertainty within the healthcare industry, the BakerHostetler Healthcare Industry team has the national presence and depth to help our clients strategically navigate challenges and respond nimbly to change.

Our clients come from a broad range of healthcare organizations, including:

  • Hospital and health systems
  • Physician practices
  • Suppliers and pharmaceutical companies
  • Long-term and post-acute care providers
  • Home health, hospice and specialized niche providers
  • Venture capital funds and private equity entities operating in the healthcare sector

We have counseled many of our clients for decades, including some of the nation’s leading medical facilities. We provide responsive and creative solutions for navigating the multitude of legal and regulatory issues involved in this heavily regulated industry.

More »

We routinely assist our healthcare industry clients to assist with or address matters and issues of concern and relevance, including:

Transactional

  • Mergers and acquisitions and divestitures
  • Private equity, venture capital funds investment in healthcare entities
  • Affiliations, joint ventures and strategic alignments
  • Portfolio company acquisition and disposal
  • Liquidity and realization events
  • Management buyouts
  • Senior, mezzanine and warrant financings
  • Strategic alignment
  • Enforcement and Corporate Governance
  • Internal investigations and corporate oversight
  • False Claims Act litigation and investigations
  • Civil investigative demands and subpoenas
  • Civil and criminal healthcare enforcement matters

Reimbursement

  • Medicare and Medicaid coding and billing reviews
  • Government and commercial pre‑payment and post-payment audits and appeals
  • Payment suspensions
  • Managed care payment disputes
  • Audits and proceedings initiated by fiscal intermediaries, program integrity contractors, and federal and state governmental authorities

Regulatory

  • Regulatory and compliance advice
  • Anti-Kickback and Stark laws
  • False Claims Act
  • Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH)
  • Emergency Medical Treatment & Labor Act (EMTALA)
  • Licensing and certification matters
  • Occupational Safety and Health Administration (OSHA)
  • Compliance program development
  • Clinical research program development

Privacy

  • Federal and state privacy law compliance
  • Data breach response, including crisis management and investigations or audits

Policy

  • Legislative and regulatory proposals involving healthcare issues
  • Communication with Capitol Hill and administration policymakers, administrative agencies and enforcement officials

Our services

We provide a full range of services to clients who need help in many different areas and matters affecting their businesses and operations. Our attorneys routinely work with clients to form new entities and ventures and assist them with the negotiation and implementation of strategic transactions. We help clients respond to data breaches and other privacy matters, identify and advise on specific fraud and abuse risk areas, support their defense 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 many different avenues, including facility acquisitions and leasing, financing arrangements, management contracts, affiliate agreements and the creation of new relationships with relevant partners.  Additionally, we counsel them on the full range of operational matters. We work with physician groups of all sizes to structure joint ventures and other relationships among physicians, physician groups, hospitals, specialty healthcare service providers and others in the industry.

Our Healthcare Privacy team excels at addressing HIPAA issues and has provided timely and discreet 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 help 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 and contracting and payment disputes, and we are experienced in 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.

Changes in administrations can create significant changes to the manner in which healthcare can be delivered and Medicare and Medicaid may be funded. Our Healthcare Public Policy team closely monitors emerging policies, advancing our clients’ interests on Capitol Hill with relevant healthcare agencies and with the then current administration. We routinely assist clients in developing legislative and regulatory proposals and legislative language to help them 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 with trade associations in partnering to advance their message.

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.
More »

Professionals

Name Title Office Email
M.J. Asensio
Columbus
+1.614.462.2622
Partner
M.J. Asensio
Partner Columbus
Elise S. Barajas
Dallas
+1.214.210.1206
Partner
Elise S. Barajas
Partner Dallas
Jonathan R. Barr
Washington, D.C.
+1.202.861.1534
Partner
Jonathan R. Barr
Partner Washington, D.C.
S. Derek Bauer
Atlanta
+1.404.256.8425
Partner
S. Derek Bauer
Partner Atlanta
Jeffrey R. Baxter
Atlanta
+1.404.946.9805
Partner
Jeffrey R. Baxter
Partner Atlanta
Edward J. Beckwith
Washington, D.C.
+1.202.861.1646
Partner
Edward J. Beckwith
Partner Washington, D.C.
Jeffrey P. Berg
Los Angeles
+1.310.442.8850
Partner
Jeffrey P. Berg
Partner Los Angeles
Joseph P. Boeckman
Columbus
+1.614.462.4737
Partner
Joseph P. Boeckman
Partner Columbus
Kevin D. Bradberry
Atlanta
+1.404.256.8783
Partner
Kevin D. Bradberry
Partner Atlanta
Ernessa M. Brawley
Atlanta
+1.404.256.8421
Partner
Ernessa M. Brawley
Partner Atlanta
David K. Brown
Atlanta
+1.404.256.8238
Partner
David K. Brown
Partner Atlanta
Sarah K. Browning
Atlanta
+1.404.946.9840
Counsel
Sarah K. Browning
Counsel Atlanta
Ian K. Byrnside
Atlanta
+1.404.256.8780
Partner
Ian K. Byrnside
Partner Atlanta
Matthew W. Caligur
Houston
+1.713.646.1355
Partner
Matthew W. Caligur
Partner Houston
John J. Carney
New York
+1.212.589.4255
Partner
John J. Carney
Partner New York
Justin Chavez
Atlanta
+1.404.946.9789
Associate
Justin Chavez
Associate Atlanta
C. Shawn Cleveland
Dallas / Houston
+1.214.210.1210 / +1.713.751.1600
Partner
C. Shawn Cleveland
Partner Dallas
Clayton W. Coley
Atlanta
+1.404.256.8244
Partner
Clayton W. Coley
Partner Atlanta
Charlotte A. Combre
Atlanta
+1.404.256.8431
Partner
Charlotte A. Combre
Partner Atlanta
Dorothy H. Cornwell
Atlanta
+1.404.256.8432
Partner
Dorothy H. Cornwell
Partner Atlanta
Payal P. Cramer
Atlanta
+1.404.256.8433
Counsel
Payal P. Cramer
Counsel Atlanta
Emily C. Crosby
Atlanta
+1.404.256.8790
Partner
Emily C. Crosby
Partner Atlanta
Michael T. Delaney
Cleveland
+1.216.861.7478
Counsel
Michael T. Delaney
Counsel Cleveland
Vimala Devassy
Atlanta
+1.404.256.8243
Partner
Vimala Devassy
Partner Atlanta
Cecily A. Dumas
San Francisco
+1.415.659.2640
Partner
Cecily A. Dumas
Partner San Francisco
Rodger L. Eckelberry
Columbus
+1.614.462.5189
Partner
Rodger L. Eckelberry
Partner Columbus
Douglas S. Eingurt
Atlanta
+1.404.459.4214
Partner
Douglas S. Eingurt
Partner Atlanta
Matthew R. Elkin
Washington, D.C.
+1.202.861.1722
Partner
Matthew R. Elkin
Partner Washington, D.C.
James V. Etscorn
Orlando
+1.407.649.4067
Partner
James V. Etscorn
Partner Orlando
Joseph E. Ezzie
Columbus
+1.614.462.4758
Partner
Joseph E. Ezzie
Partner Columbus
Eric R. Fish
New York
+1.212.589.4647
Partner
Eric R. Fish
Partner New York
Stephen M. Floyd
Atlanta
+1.404.256.8424
Partner
Stephen M. Floyd
Partner Atlanta
Elizabeth Price Foley
Washington, D.C.
+1.202.861.1619
Of Counsel
Elizabeth Price Foley
Of Counsel Washington, D.C.
Amy E. Fouts
Atlanta
+1.404.256.8434
Partner
Amy E. Fouts
Partner Atlanta
Lynn S. Garson
Atlanta
+1.404.256.6695
Counsel
Lynn S. Garson
Counsel Atlanta
Jenny G. Givens
Dallas
+1.214.210.1217
Partner
Jenny G. Givens
Partner Dallas
Kimberly C. Gordy
Houston / Seattle
+1.713.646.1360 / +1.206.566.7091
Partner
Kimberly C. Gordy
Partner Houston
Elizabeth A. Green
Orlando
+1.407.649.4036
Partner
Elizabeth A. Green
Partner Orlando
Kyle R. Gregory
Atlanta
+1.404.459.4218
Associate
Kyle R. Gregory
Associate Atlanta
Jarvarus A. Gresham
Atlanta
+1.404.946.9791
Associate
Jarvarus A. Gresham
Associate Atlanta
Patrick H. Haggerty
Cincinnati
+1.513.929.3412
Partner
Patrick H. Haggerty
Partner Cincinnati
Laura M. Haskins
Atlanta
+1.404.256.6691
Partner
Laura M. Haskins
Partner Atlanta
Mark Hatcher
Columbus
+1.614.462.4765
Partner
Mark Hatcher
Partner Columbus
Lori A. Herf
Columbus
+1.614.462.2667
Senior Advisor for Government Relations
Lori A. Herf
Senior Advisor for Government Relations Columbus
Scott C. Holbrook
Cleveland
+1.216.861.7325
Partner
Scott C. Holbrook
Partner Cleveland
Susan Whittaker Hughes
Cleveland
+1.216.861.7841
Partner
Susan Whittaker Hughes
Partner Cleveland
Kristen L. Jackson
Chicago
+1.312.416.6233
Partner
Kristen L. Jackson
Partner Chicago
Christian B. Jones
Washington, D.C.
+1.202.861.1617
Senior Advisor
Christian B. Jones
Senior Advisor Washington, D.C.
Joann Gallagher Jones
Atlanta
+1.404.256.8435
Partner
Joann Gallagher Jones
Partner Atlanta
Mark A. Kadzielski
Los Angeles
+1.310.442.8815
Partner
Mark A. Kadzielski
Partner Los Angeles
Ferve E. Khan
New York
+1.212.589.4269
Counsel
Ferve E. Khan
Counsel New York
Shannon A. Kidwell
Atlanta
+1.404.256.8416
Counsel
Shannon A. Kidwell
Counsel Atlanta
Winston S. Kirton
Washington, D.C.
+1.202.861.1715
Partner
Winston S. Kirton
Partner Washington, D.C.
Richard M. Knoth
Cleveland
+1.216.861.7412
Partner
Richard M. Knoth
Partner Cleveland
Theodore J. Kobus III
New York
+1.212.271.1504
Partner
Theodore J. Kobus III
Partner New York
Jay P. Krupin
Washington, D.C.
+1.202.861.1700
Partner
Jay P. Krupin
Partner Washington, D.C.
Mark S. Lange
Atlanta
+1.404.256.6686
Partner
Mark S. Lange
Partner Atlanta
Raymond M. Malone
Cleveland
+1.216.861.7879
Partner
Raymond M. Malone
Partner Cleveland
Wendy W. Markham
Atlanta
+1.404.256.8248
Partner
Wendy W. Markham
Partner Atlanta
Lori P. Markley
Atlanta
+1.404.459.4213
Regulatory Analyst
Lori P. Markley
Regulatory Analyst Atlanta
Brian F. McEvoy
Atlanta
+1.404.256.6696
Partner
Brian F. McEvoy
Partner Atlanta
Charlene L. McGinty
Atlanta
+1.404.256.8232
Partner
Charlene L. McGinty
Partner Atlanta
John J. McGowan Jr.
Cleveland
+1.216.861.7475
Partner
John J. McGowan Jr.
Partner Cleveland
M. Scott McIntyre
Cincinnati
+1.513.852.2622
Partner
M. Scott McIntyre
Partner Cincinnati
Michael W. Mengis
Houston
+1.713.646.1330
Partner
Michael W. Mengis
Partner Houston
Jacqueline T. Menk
Atlanta
+1.404.946.9776
Associate
Jacqueline T. Menk
Associate Atlanta
Frank C. Miller
Columbus / San Francisco
+1.614.462.4748 / +1.415.659.2648
Partner
Frank C. Miller
Partner Columbus
James R. Morrison
Seattle
+1.206.332.1108
Partner
James R. Morrison
Partner Seattle
Patrick M. Muldowney
Orlando / New York
+1.407.649.4002 / +1.212.847.7066
Partner
Patrick M. Muldowney
Partner Orlando
Eric A. Packel
Philadelphia
+1.215.564.3031
Partner
Eric A. Packel
Partner Philadelphia
Francis B. Palumbo
Washington, D.C.
+ 202.861.1701
Of Counsel
Francis B. Palumbo
Of Counsel Washington, D.C.
Janis M. Penman
Washington, D.C.
+1.202.861.1622
Partner
Janis M. Penman
Partner Washington, D.C.
Sally Yuanyuan Qin
Washington, D.C.
+1.202.861.1781
Partner
Sally Yuanyuan Qin
Partner Washington, D.C.
Carole S. Rendon
Cleveland
+1 216.861.7420
Partner
Carole S. Rendon
Partner Cleveland
Lauren J. Resnick
New York
+1.212.589.4241
Partner
Lauren J. Resnick
Partner New York
Patrick H. Rose IV
Dallas
+1.214.210.1220
Partner
Patrick H. Rose IV
Partner Dallas
Lee H. Rosebush
Washington, D.C.
+1.202.861.1567
Partner
Lee H. Rosebush
Partner Washington, D.C.
Paul Rosenberg
New York
+1.212.589.4299
Partner
Paul Rosenberg
Partner New York
Robert M. Rozier
Atlanta
+1.404.256.8247
Partner
Robert M. Rozier
Partner Atlanta
Kimberly S. Ruark
Atlanta
+1.404.256.6699
Counsel
Kimberly S. Ruark
Counsel Atlanta
Robert K. Rupp
Columbus
+1.614.462.2688
Partner
Robert K. Rupp
Partner Columbus
Gregory S. Saikin
Houston
+1.713.646.1399
Partner
Gregory S. Saikin
Partner Houston
Lynn Sessions
Houston
+1.713.646.1352
Partner
Lynn Sessions
Partner Houston
Lance L. Shea M.S., J.D.
Washington, D.C.
+1.202.861.1648
Partner
Lance L. Shea M.S., J.D.
Partner Washington, D.C.
Amy M. Shepherd
Columbus
+1.614.462.4712
Partner
Amy M. Shepherd
Partner Columbus
Alyse F. Stach
Philadelphia
+1.215.564.5768
Counsel
Alyse F. Stach
Counsel Philadelphia
Erica Svoboda
Atlanta
+1.404.256.6693
Of Counsel
Erica Svoboda
Of Counsel Atlanta
Christopher J. Swift
Cleveland
+1.216.861.7461
Partner
Christopher J. Swift
Partner Cleveland
Gregory A. Tanner
Atlanta
+1.404.256.8237
Associate
Gregory A. Tanner
Associate Atlanta
Tyler M. Thompson
Washington, D.C.
+1.202.861.1571
Senior Advisor
Tyler M. Thompson
Senior Advisor Washington, D.C.
Amy J. Traub
New York
+1.212.589.4248
Partner
Amy J. Traub
Partner New York
Peter W. Van Euwen III
Cleveland
+1.216.861.7598
Partner
Peter W. Van Euwen III
Partner Cleveland
Gary A. Wadman
Columbus
+1.614.462.2678
Partner
Gary A. Wadman
Partner Columbus
Marc N. Wagner
Washington, D.C.
+1.202.861.1557
Associate
Marc N. Wagner
Associate Washington, D.C.
Daniel R. Warren
Cleveland / Chicago
+1.216.861.7145 / +1.312.416.8179
Partner
Daniel R. Warren
Partner Cleveland
Leah Fressell Watkins
Atlanta
+1.404.256.8249
Regulatory Analyst
Leah Fressell Watkins
Regulatory Analyst Atlanta
Alec Wightman
Columbus
+1.614.462.2636
Partner
Alec Wightman
Partner Columbus
Robert M. Wolin
Houston
+1.713.646.1327
Partner
Robert M. Wolin
Partner Houston

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
    • Nationwide: Highly Regarded (2022)
      • Band 1
    • Georgia (2015 to 2022)
      • Band 2
    • Ohio (2011 to 2022)
      • Band 3
    • Texas (2009 to 2022)
      • Band 5
  • Chambers USA: Healthcare: Pharmaceutical/Medical Products Regulatory
    • District of Columbia (2021 to 2022)
      • Band 4
  • Chambers Global: Privacy & Data Security: Healthcare Spotlight Table – Nationwide (2021 to 2022)

News

News

Press Releases

Publications

Alerts

Articles

Podcasts

Blog Posts

Events

Related Services

Key Contacts

Blog

In The Blogs

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