Integration of Behavioral Health and Physical Medicine

Throughout the United States, Behavioral Health Care is carved out of the mainstream medical health care system in terms of delivery of care, providers, and reimbursement. For nearly 30 years, Clark Hill’s Behavioral Health Care lawyers have been involved in the psychiatric rehabilitation evolution together with the legal implications of managed behavioral health care. Clark Hill has assembled an experienced, dedicated team of lawyers, paralegals, psychiatrists, nurses, and claims assessment specialists devoted to serving behavioral health care recipients, providers, and managed care companies. One of Clark Hill’s Behavioral Health Care lawyers and a consulting psychiatrist recently published an article regarding cutting edge issues involving the “Collision of the Behavioral Health Recovery Model with the American Legal System.”

"No right is held more sacred, or is more carefully guarded, by the common law, than the right of every individual to the possession and control of his/her own person, free from all restraint or interference of others, unless by clear and unquestioned authority of law.”

- United States Supreme Court


Our clients have the luxury of choosing from many accomplished law firms that deliver high quality and cost effective legal services. What distinguishes Clark Hill’s Behavioral Health Care Team, however, are intangible factors – factors that benefit our clients. For example, the Clark Hill lawyers enjoy their work. The lawyers enjoy the challenge of meeting and exceeding an unbalanced burden of proof in representation of the behavioral health care clients. In civil litigation, the recognized burden of proof is a “preponderance of the evidence” (more than 50%). However, due to negative stigma and hindsight bias to be successful in civil litigation, the burden of proof, in reality, is “clear and convincing.” These challenges, generated through the behavioral health delivery system, create excitement, and trigger the talents and creativity of the Clark Hill’s Behavioral Health Care team.

The ultimate goal of each member of the Behavioral Health Care Team is to become more than just a lawyer for our clients. Our goal is to become a trusted counselor and advisor for all aspects of our clients’ work.

Hands On Experience Translates Into Expertise

Clark Hill’s Behavioral Health Care Team represents behavioral health care providers in numerous states related to procurement, administrative law, contract disputes, licensing, claims disputes, Medicaid reimbursement matters, government regulatory compliance, malpractice defense, Centers for Medicare and Medicaid Services (“CMS”) sanctions, fraud and abuse, qui tam actions, healthcare financing, creation and operation of managed care organizations, labor and employment law services and corporate compliance program development, education and maintenance. The lawyers at Clark Hill are familiar with government managed care contracts and the issues affecting all providers generated through ongoing governmental regulation.

Clark Hill’s Behavioral Health Care Team participates in the policy development groups that focus on creating methodologies to integrate the delivery of medical and behavioral health care. At Clark Hill you will find that the Behavioral Health Care lawyers supply value added services to clients because their experience in the Behavioral Health Care arena has been hands on.



● Representing behavioral health care providers challenging biased governmental procurement
● Challenging and defending procurement contracts for Medicaid and Medicare services
● Responding to RFP for Medicaid and Medicare services
● Consulting regarding Integrated Model RFP submittals


● Representing clients in the formation, organization, merger and acquisition of long term care facilities
● Negotiating contracts with Medicaid and Medicare managed care companies
● Negotiating rate revisions on behalf of long term care entities
● Handling claim disputes on behalf of long term care facilities with private and government payors
● Participating in drafting of licensure survey plans of correction and licensure appeals
● Preparing medical director agreements
● Handling state agency self-reporting issues for resident abuse and neglect
● Providing consultation for day-to-day operating activities as general counsel


● Representing providers regarding alleged violations of federal and state false claims acts
● Preparing and delivering presentations to clients regarding methods to avoid and mitigate audit inquiries
● Representing providers in state and federal audits
● Representing clients in Stark and Anti-kickback analysis in hospital/physician arrangements, home health and long term care arrangements with physicians, vendors, and suppliers


● Facility acquisitions and vertical integration
● Creating viable third Party Administrators
● Horizontal integration of behavioral health providers
● Reorganization of multi-specialty groups
● Consulting on information technology agreements
● Preparing employee leases and management service contracts
● Reviewing, analyzing, and drafting facility policy and procedure manuals


● Represent physicians, nurses, nurse practitioners, BH providers and facilities in claims against licenses, renewals and reporting
● Licensing of new facilities
● Represent facilities in the appeal of adverse action determinations


● 35 years’ experience in Medicaid and Medicare claims disputes
● Representing providers in literally thousands of administrative hearings for denied claims regarding issues of medical necessity, short-pay, prior and continued authorization, recoupment, rate changes, inaccurate submittals, waiver and estoppel
● Consulting with clients for development of claim submittal, policies and procedures
● Representing behavioral health providers in Medicare Advantage and ERISA claim disputes
● Counsel and advise clients on the development and growth of international partnerships and medical travel


● Creating employment agreements tailored to tele-psychiatry
● Draft independent contractor agreements for (Locum tenens)
● Establishing physician group contracts
● Constructing hospital based physician services agreement including laboratory, emergency department, etc.
● Develop outpatient psychiatric service clinics
● Develop psychiatric unit
● Management and Co-Management Agreements


● Created a workable and affordable Behavioral Health Care Compliance Institute
● Real time knowledge of HIPAA rules, policies and procedures
● Counseling and advising clients regarding patient confidentiality
● Advising clients regarding OIG self-disclosure requirements
● Completing and complying with CMS Audit requirements


● Representing behavioral health providers in coverage issues, reinsurance issues and policy language disputes
● Handling tenders of defense and demands for contractual indemnification
● Acting as counsel of choice for behavioral health providers in medical negligence lawsuits


● Consulting regulatory monitoring requirements
● Supplying medical malpractice defense regarding misuse of pharmaceuticals


● Supplying real time advice regarding the highly nuanced CMS regulatory scheme
● Creating practical solutions for implementation of internal policies to comply with federal and state statutes, regulations and procedures


● Planning and implementing integration strategies to help clients stay relevant in the world of health care reform
● Developing and negotiating joint venture and other collaborative ventures
● Developing and negotiating third party payor agreements
● Counsel and assist clients with development and application for demonstration project funding
● Counsel and advise clients on servicing dual-eligible population
● Counsel and advise clients on development and participation in Accountable Care Organizations, Patient Centered Medical Homes and other alternative deliver models


● Providing defense to behavioral health facilities relating to patient and employee injuries


● Medical malpractice—psychiatric
● Medical malpractice—BH professionals
● Medical malpractice—psychiatric and integrated clinics
● Medical malpractice—psychiatric hospitals
● Medical malpractice—long term care facilities
● Medical malpractice—Psychiatric Urgent Care
● Medical malpractice—Psychiatric Emergency Care—EMTALA
● Directors and officers liability claims


● Preparing risk contracts
● Creating risk pool arrangements
● Negotiating skilled nursing facility and free standing psychiatric clinic managed care contracts
● Drafting managed care contracts for providers of Medicaid and Medicare services
● Development of managed care provider networks and administrative service organizations for MCPNS


● Handling ERISA preemption litigation
● Handling benefit coverage cases to ensure providers are paid
● Consulting on COBRA issues
● Pursuing claims payment against Plan Administers


● Pursuing lien rights on behalf of Medicaid and Medicare providers
● Pursuing state statutory and lien statutes for behavioral health and acute care providers
● Consulting regarding contract obligations for providers’ obligations to pursue CMS and State liens


● Advising and consulting clients regarding criminal history/background checks for behavioral health care providers, investigations regarding allegations of discriminatory/ retaliatory conduct
● Preparing personnel handbooks and policy manuals
● Consulting on FMLA issues and other employment related issues including EEOC appeals and lawsuits
● Preparing and pursuing appeals to state and federal courts from administrative decisions
● Advising clients regarding wage and labor issues and representing them in DOL investigations


● Creating non-profit corporations to take advantage of grants and other funding
● Expertise includes tax analysis


● Litigating for claims payments
● Litigating in state and federal administrative hearings
● Trying cases in state and federal court
● Representing clients in Arbitration
● Conducting Mediation


● Pursuing third party liability claims
● Pursuing statutory and regulatory liens
● Pursuing secondary payors for unpaid claims

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