Capabilities

In Brief: A Digest of Physicians Projects

Client Results

Formed joint ventures involving equity participation by physicians in medical facilities such as specialty hospitals, imaging centers, ambulatory surgery centers, medical office buildings, parking facilities and other service lines.
Structured break-up of a large Midwestern ophthalmic physician practice into nine separate practices through 22 transactions closing simultaneously.
Represented physician groups in audits by Medicare Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs) and other auditors, including appeal of denials through Medicare appeals process.
Developed and tailored comprehensive compliance plans utilizing effective audit tools for various healthcare providers, including physician practices, and advised such providers regarding compliant billing and coding practices.
Advised providers, employers, plans, business associates and insurers with respect to all aspects of employment benefits and compensation matters relating to the healthcare industry, including the Patient Protection and Affordable Care Act, contracting health insurance marketplaces and exchanges (whether state run, federally assisted or the federal marketplace.)
Represented a large healthcare provider in the development of a new system-wide physician employment model and compensation methodology and facilitated the transition of more than 100 employed physicians to the new model.
Evaluated various quality bonus programs for employed and contracted physicians, including facilitating valuation efforts, and assisted with development of quality initiatives, benchmarks and bonus methodology.
Provided counsel for False Claims Act and state Medicaid fraud prevention investigations and litigation experience for providers, including a dentist in Medicaid fraud litigation where state sought in excess of $50 million in statutory damages and penalties.
Represented physician groups in responding to third party discovery served in litigation concerning Stark and anti-kickback violations.