Physician Immigration J1/H1B

J-1 Waivers for Physicians
J-1 physicians who have entered the United States through sponsorship form Educational Commission on Foreign Medical Graduates (ECFMG) for clinical training (residency and fellowship training) are subject to a two year home residence requirement. These physicians are not permitted to change to H or L status, or apply for a green card, until they have returned to their home country for a period of two years, or until they have been granted a waiver of the two year home residence requirement. Waivers can be very difficult to obtain. Even doctors who marry a US Citizen cannot secure a US Immigrant Visa (“green card”) without a waiver, or satisfying the two year requirement.
 
The waivers available to J-1 physicians include interested government agency waivers, persecution waivers and hardship waivers.
 
Clark Hill’s Immigration Practice Group has extensive expertise with J-1 and H-1B Physicians, J-1 waivers and green cards for Physicians. Please hit the “contact us” link below if you would like a free publication.
 
IGA Waivers
Interested government agency (IGA) waivers can be granted to those J-1 physicians who are sponsored by an employer based on a commitment to work for at least three years in a medically under-served area of the US. There are several agencies willing to support a J-1 waiver, including the Department of Veterans Affairs (VA), the Appalachian Rural Commission (ARC); and the Department of Health and Human Services (HHS), Delta Regional Authority. In addition, each state is permitted to grant up to thirty waivers each year (Conrad State 30 Program).
 
In order to be granted a waiver, the employer and the physician must comply with several requirements. They must demonstrate that they have entered into an employment contract, confirming that the physician will work for 40 hours per week, for a minimum of three years. Employers must be able to show that they have engaged in recruitment to search for minimally qualified US workers. The employer must also demonstrate that the work will take place in an area that has been designated by HHS as medically under-served, with two exceptions. First, a waiver sponsored by the VA does not require the work to be in an under-served area. Second, each state, through its Conrad State 30 Program, is permitted to grant up to five waivers for work that is not located in an under-served area, at the states' discretion. The waiver is initially filed with the interested government agency; then forwarded to the US Department of State, and finally to the US Citizenship and Immigration Services (USCIS). Processing times vary from 4-16 weeks. It is important to note that timing is a concern, especially if an employer is processing the J-1 waiver through the Conrad State 30 Program. Many states have established set application periods. Employers and Physicians will need to be aware of these deadlines in states that receive large numbers of J-1 waiver applications.
 
Hardship Waivers
Hardship waivers can be granted to those J-1 physicians who are able to demonstrate extreme hardship to a qualifying relative, including a US citizen or lawful permanent resident spouse and/or child. He/she must show that the qualifying relative would suffer extreme hardship both if the J-1 physician returned to his/her home country without the qualifying relative for two years, and that the qualifying relative would suffer extreme hardship if he/she returned to the J-1 physician's home country for two years. Extreme hardship can be demonstrated through medical, psychological, financial, and educational means. The waiver is initially filed with USCIS. If USCIS agrees that the qualifying relative would suffer extreme hardship if the two year home residence requirement is enforced, the waiver is forwarded to the US Department of State for their opinion. If the US Department of State also determines that extreme hardship exists, the waiver decision is sent to USCIS, where the waiver can be granted.
 
As an alternative, a J-1 physician is also permitted to apply for an O-1 visa see our page regarding O-1 visa requirements. Note that a J-1 physician is not permitted to change his/her status from J-1 to O-1 in the US. The O-1 petition must first be approved by a USCIS Regional Service Center, and then the J-1 physician must apply for the O-1 visa at a US Consulate abroad. Also, note that is the J-1 physician is able to obtain an O-1 visa, he/she still remains subject to the two year home residence requirement.
 

H-1B Visas
US employers frequently use the H-1B Visa category to quickly hire foreign nationals. A foreign national generally qualifies for H-1B status if he/she holds at least a US Bachelor’s Degree (or equivalent) relevant to the field in which he/she will be working, and the position normally requires at least a Bachelor’s Degree as an entry-level requirement to perform the job. The H-1B Visa must be sponsored by a US employer. The H-1B Visa is usually granted for three years, and extended up to a maximum of 6 years. Any time spent in the US working for another employer in H-1B or L-1 Visa status will count against the 6 year limit. Another 6 years of H-1B Visa time may be available once the foreign national spends one full year outside the US. Foreign nationals may seek US Immigrant Visa (“green card”) status while on an H-1B Visa.
 
A petition for H-1B status must be filed with the US Citizenship and Immigration Services (USCIS) Regional Service Center no more than 6 months before the requested start date. The USCIS may take several months to process an H-1B. However, for an additional $1,225.00 processing fee, the USCIS will review the petition in 15 days.
 
H-1B Extensions Beyond 6 Years
Extending H-1B Visas beyond the 6 year limit is possible in some circumstances. Specifically, if the first step in the green card process (Immigrant Worker petition or PERM Labor Certification) is filed before the end of the foreign national’s 5th year in the US on an H-1B, then generally the H-1B can be extended one year at a time until the green card is approved or denied. Alternatively, if the H-1B employee cannot finalize his/her green card status because of priority date backlogs, then generally a 3 year extension can be secured, as long as the I-140 Immigrant Worker Petition is approved, and the green card case remains pending. For more on employment based green card processing see the Clark Hill website. Finally, time spent out of the US while on an H-1B, can be added to the time an H-1B employee can work in the US. This is referred to as recapture, and in general, any credible proof is accepted (passport stamps, copies of airline tickets, etc.
 
H-1B Cap
The US government limits the number of new H-1B Visas to 65,000 per year (the government’s fiscal year runs from October 1 to September 30). Once this limit, or “cap”, is reached, an employer cannot employ a foreign national in H-1B status until the next fiscal year begins. It is important to note that foreign nationals who currently hold H-1B status and are either extending and/or amending that H-1B status, or are seeking H-1B status with another employer, are generally not subject to the cap. Foreign nationals who will be employed at and in furtherance of the basic or applied research of a governmental or non-profit research organization, or an institution of higher learning (college or university), are not subject to the cap. Finally, J-1 physicians who have been granted a waiver to work in a medically undesired area are also exempt from the cap. For more on J-1 waivers, see the Clark Hill website.
 
20,000 additional H-1B's, beyond the 65,000 listed above, are available to foreign nationals who have a Master Degree, or other advanced degree, from a US college or university.
 
Wages
The employer must pay the H-1B worker the wage it pays similarly experienced US workers for the same job in the same location, or the wage as determined by a required wage survey, whichever is higher. H-1B workers generally must be paid from the sponsor’s US payroll. H-1B workers should not pay for any H-1B costs or attorney fees.
 
H-1B Portability
H-1B portability allows a foreign national, who currently holds H-1B status, to change employers more quickly. Once the new employer files an H-1B petition, and it has been received by the USCIS, employment with the new company may commence. This saves significant time, as the employer does not have to wait for approval of the H-1B, which could take several months. In some cases H-1B workers may travel internationally while utilizing H-1B portability.
 
H-1B Extensions
H-1B employees who have a timely filed extension of status filed and pending are allowed to work for up to 240 days, while the extension is pending. International travel is not permitted once the status expires, even though the H-1B employee can continue working.
 
Changing H-1B Status and International Travel
A foreign national in the US in a lawful immigration status (other than H-1B), who is applying for a change to H-1B status, generally should not travel outside the US while his/her H-1B petition is pending. The USCIS can deny a change of status petition if it determines that a foreign national has departed the US while the H-1B petition is pending. However, these international travel limitations may not necessarily apply for foreign nationals changing from one H-1B employer to another H-1B employer.
 
Family Members
The H-4 Visa is available to the spouse and children (under the age of 21) accompanying the H-1B applicant to the US. The H-4 Visa is generally granted for the same period as the H-1B employee, and must be extended accordingly. As with H-1B change of status petitions, international travel should be postponed for those filing a change to H-4 status. Time spent in the US on an H-4 does not count against that foreign national’s 6 year limit on an H-1B, as described above, if he/she obtains a separate H-1B. H-4s are not eligible for US social security numbers, but can apply for ITINs with the US Internal Revenue Service. H-4s cannot work, but can attend school or a university
 

Experience

Assisted clients on how to respond to growing demands to make their companies and products more sustainable, a goal increasingly being adopted by companies in the health care industry

Commented on EPA rulemaking s for a trade association representing a segment of in the health care industry 

Tracks regulatory developments for health care industry clients to provide early warning of significant new regulations or risks to a company's business, particularly concerning issues relating to FIFRA compliance for chemicals which claim to reduce Ebola, norovirus, and other viruses that are unlikely to have been explicitly testing in the original pesticide registration process 

Advised on methods of responding to regulatory agency and press concerns about the presence of "toxic" chemicals in products used by the health care industry

With assistance from  Kristi Gauthier,  Ed Hammond, Peter Domas and Bishop Bartoni, Kevin Hendrick and Nicole Tersigni successfully defended an insurance priority dispute, resulting in an extremely favorable judgment for firm client, United States Steel Corporation’s ERISA-governed Retiree Benefits Plan.  U. S. Steel Retirement Plan was joined as a third-party defendant in a pending dispute by a No-Fault Automobile Insurance carrier,  which had been sued by a healthcare service provider for unpaid patient attendant care fees.  The No-Fault Carrier claimed that the obligation to pay for these services under Michigan No-Fault law  fell to U. S. Steel Retirement Plan, which covered the patient (who was a former U. S. Steel employee).  Ed, Bishop, Kristi and Peter lent their expertise to Kevin and Nicole in interpreting alleged conflicting insurance priority provisions and explanations of benefits.  Kevin and Nicole crafted a legal argument that ultimately led to summary disposition in favor of U.S. Steel Plan, and against the No-Fault carrier, saving U.S. Steel Plan from payment of the healthcare fees, and also reimbursing U.S. Steel Plan for benefits it had earlier paid by mistake, out of priority.  As the No-Fault carrier had rejected the Case Evaluation award prior to the filing of cross motions for summary disposition, it also appears that attorney  fees are recoverable for our client.  Kristi and Ed on Employee Benefit law, Bishop on Michigan No-Fault law, and Pete on Health Care issues, proved to be unbeatable resources.

Managed Care and Health Care Industry Litigation - Practiced before state and federal agencies and the courts relating to Medicare and Medicaid reimbursement issues.

Formation of joint ventures among physicians.
Represented major corporation in various acquisition and divestiture transactions involving developing technology.
Represented non-profit hospital in a conversion to for-profit status.
Represented nephrology clinics in a merger into a publicly traded company.
Represented hospital in merger transaction.

Health Care Industry Litigation - Participated and litigated in several federal bankruptcy and state court receivership proceedings of hospitals.

Antitrust and Trade Regulation - Lead Counsel in an antitrust case which successfully put an end to a decade’s long boycott against one of the largest dental insurers in the country.

Managed Care and Health Care Industry Litigation - Counseled clients and litigated third party reimbursement and accounting for reimbursement issues.

Formation of and counsel to medical professional corporations.
Formation of joint ventures between hospitals and physicians.
Representation of medical billing companies.
Representation of medical staffs and hospitals on amendments to medical staff bylaws.
Representation of rehabilitation entities.
Represented parties in sales of medical practices to hospitals and in divestitures of medical practices from hospitals.

Antitrust and Trade Regulation - Reported antitrust decisions include the following: Pennsylvania Dental Association v. Medical Service Association of Pennsylvania, 815 F.2d 270 (3d Cir. 1987), rev’g, 632 F.Supp. 653 (M.D. Pa. 1986), cert denied, 484 U.S. 851 (1987); Pennsylvania Dental Association v. Medical Service Association of Pennsylvania, 745 F.2d 248 (3d Cir. 1984), aff’g, 574 F.Supp. 457 (M.D. Pa. 1983), cert. denied, 471 U.S. 1060 (1985).

Antitrust and Trade Regulation - Antitrust litigation experience includes representing clients in the insurance, health care, soft drink, construction, manufacturing, hardware and building materials industries.

Represented physician parties in corporate split-ups.

Managed Care and Health Care Industry Litigation - Litigated provider participation status under the Medicare program.

Managed Care and Health Care Industry Litigation - Litigated issues related to institutional providers’ Medicaid cost reports.

Counsel to mid-market health care companies including cancer treatment centers, dialysis centers, sleep labs, and ambulatory surgery centers providing lead counsel and coordinating legal counsel on a wide array of matters including corporate matters, operations, acquisition and divestiture transactions, joint venture projects, corporate governance, business planning and financial transactions, and legal compliance.

Represent healthcare insurers, third party administrators, managed care organizations and others in contractual, business and other disputes. Representation includes counseling clients and litigating issues regarding payments, accounting for payments, third party administration and self-insured health plan issues, fraud claims, among others

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Moore Featured on Michigan Talk Radio NPRClark Hill PLC Immigration and Health Care Attorneys Present “Life After Training: Options For J-1 And H-1B Physicians” November 14 in TroyClark Hill Attorney Gregory W. Moore to Speak at Southwest Michigan Physician IT Summit “Preparing Your Practice for EMR Adoption”Clark Hill Attorney Kristi R Gauthier Elected to Board of Variety FAR Conservatory of Therapeutic and Performing Arts
Articles
Andrew Turk Named 2017 Top AZ Business Leader by AZ Business MagazineRelationships & the Law Today: Protecting Your Interest in Shared Assets after Blumenthal v. Brewer - Windy City Times, October 19, 2016Relationships & the Law Today: Married on Sunday, Fired on Monday: Recent Developments in Employment Law - September 21, 2016Jud DeLoss Quoted in Alcoholism & Drug Abuse Weekly: Illinois residents with good insurance targeted by Florida provider – June 13, 2016Gerald DeLoss Quoted in "How Electronic Health Records Can Hurt You in Malpractice Suits" By InsureonTop 10 Health Law Issues 2016 by AHLA Connections Health Attorney Gerald DeLoss: Data Sharing, Use Agreements in the Midst of an Evolution (Q&A) in FierceEMR - February 5, 2016Gun safety: HIPAA change allows providers to report on some mentally ill patients No Pharmacist Duty to Monitor Patient Prescription History by Courtney Posnik in IAHA Magazine Overpayments: Key Issues Physicians Should Consider, Legal Matters, The ChicagoDoctor.com - Part 2 of 2Overpayments: Key Issues Physicians Should Consider, Legal Matters, The ChicagoDoctor.com - Part 1 of 2Relationships & Law Today: Healthcare Decision-Making for the LGBTQ Community - August 12, 2015The Hospital Readmission Reduction Program: Fraud and Abuse Concerns - Spring 2015Story Behind 'The SGR Fix' in 900 Words or Less - Healthcare Michigan, May 2015Patient-Physician Confidentiality: 'Til Death Do Us Part?A Crystal Ball: Managed Care Litigation in Light of the Patient Protection and Affordable Care Act, The Health LawyerHealth Care Without Borders in DBusiness, November-December 2014Thinking of Investing In, or Renting Space In, an ASC? Have You Taken Compliance into Consideration?"Not-So-Friendly Competition" in Sleep Review: The Journal for Sleep SpecialistsHow to Legally Break Up With Your PatientHospital Incentives to PhysiciansHospital Incentives to PhysiciansManagement and Third-Party Billing CompaniesManagement and Third-Party Billing Companies Reporting Post-Operative Pain Management Procedures in 2013A Survey of State Prompt Pay Laws, Part IISo You're Thinking of Getting into the Business of Healthcare? Here Are the Top 5 Things You Need to KnowA Survey of State Prompt Pay Laws, Part IWhat You Need to Know About the Supreme Court's Decision on Health Care ReformSocial Media Policies: Do I Really Need One?Five Steps to Protect Your Organization from HIPAA AuditsThe Required Hospital Standard Charge Publication That You Probably Missed, American Health Lawyers Association Hospitals & Health Systems RXAnesthesiologists Should Beware of HIPAA Audits
Presentations
Webinar: The Economics of Medical Practice under HIPAA/HITECHWebinar: Entrepreneurial Medicine: Opportunities to Enhance Your Practice and Bottom LineWebinar: Physician Compensation Reform: How You Will Get PaidA Risk Manager, Claims Manager and Lawyer Walk Into a Bar..Physician Webinar Series
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Nursing Home Litigation with Andrew Turk By The Legal Broadcast Network