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
Healthcare Law
Leader
Healthcare Law
Director
Long Term Care Compliance Institute
The need for an effective Compliance Program has never been greater! The Affordable Care Act armed the government and its contractors with more tools to combat regulatory noncompliance, and in the past few years, there have been record highs in settlements, recoupments and arrests tied to fraudulent healthcare arrangements. Operating under the status quo is no longer acceptable and is proving to cost providers millions of dollars in lost revenue and penalties every day.
Every provider must be on the right side of compliance. Compliance is not just a set of policies sitting on a shelf; it is a culture and a way of conducting business. The Long Term Care Compliance Institute is a one-stop-shop for LTC's to establish and implement an effective Compliance Program. This Institute will help providers understand the intricacies of LTC compliance through educational programs; assist in creating a culture of compliance through an individualized risk assessment, drafting entity-specific Compliance Policies, and onsite staff training; and provide guidance on maintaining acceptable levels of compliance in everyday practice.
The LTC Institute is a scalable product designed specifically for the LTC community. Regardless of the size of your community or the number of programs offered within it, we have a Compliance Program design for your organization that is appropriately scaled and affordable.
Every participant in the LTC Compliance Institute can have trust, and confidence in, the strength of Clark Hill’s team supporting the Institute. Comprised of attorneys with well over 200 years in healthcare experience, former Assistant United States Attorneys, and a former Assistant State Attorney General, the Institute not only has the subject matter experts that participants need, but the on-the-ground experience participants depend on.
Participants in the Institute shall also receive the following benefits:
- Individualized Compliance Plan development and drafting;
- Personalized training and education on how to implement your Compliance Plan;
- Access to sample Policies and Procedures which are updated in real time based on new developments;
- Hotline availability for reporting compliance concerns;
- Quarterly round table meetings to discuss the latest developments affecting your Compliance Program;
- Periodic newsletters;
- Real time Alerts on important compliance updates;
- Compliance committee assistance and agenda development;
- Compliance committee chair (upon request);
- Discounted rate on compliance investigations and audit protocols;
For more information about the benefits of the Long Term Care Compliance Institute and how the team at Clark Hill can assist your organization with developing and implementing an effective Compliance Program, please contact any member of our team at 1-800-949-3120.
Experience
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
