Healthcare

 

Healthcare Business

Healthcare Business Transactions: Business transactions involving healthcare providers and facilities often raise unique issues. At Cooper & Riesterer, we combine our in-depth knowledge of the healthcare industry and the intricate and ever-changing regulatory framework that governs it with our extensive experience with traditional business transactions and operational considerations in assisting clients in structuring their business relationships in compliance with federal and state regulations, including licensing requirements, fraud and abuse laws, and referral and reimbursement constraints.

We represent healthcare providers in a wide variety of business matters, including:

  • Entity structure and formation
  • Due diligence
  • Corporate governance
  • Shareholder/partnership agreements
  • Business associate agreements
  • Management service contacts
  • Real estate matters
  • Buyout agreements
  • Lease agreements
  • Vendor and supplier agreements

Healthcare Employment Matters

We combine our unique healthcare and business expertise to safeguard our client’s best interests in drafting and reviewing employment contracts, either for employers or prospective employees. We draft and review contracts, resolve contract disputes, and can address a wide variety of concerns relating to healthcare employment contracts, including:

  • Compensation package negotiation
  • Physician restrictive covenants (non-compete contracts)
  • Access to medical billing records in order to adequately defend against potential government investigations, payor audits, or other third-party claims
  • Limitations on liability arising from recovery of overpayments by a third-party payor
  • Malpractice insurance and tail coverage

Healthcare Franchising

At Cooper & Riesterer, we combine our extensive experience in the specialty areas of franchising and healthcare business to provide comprehensive representation to established healthcare franchisors, as well as those new to the healthcare franchise industry. We also represent franchisees considering investment in or already operating an existing healthcare franchise. For information about our franchise-related services, visit our franchise page.

Professional Licensing and Staff Privilege Matters

We represent physicians, allied health professionals, and other healthcare providers. The effects of medical professional licensure and medical staff privileging and credentialing matters can have far reaching consequences. At Cooper & Riesterer, we have significant experience in these matters and can help you successfully navigate these sensitive and important issues.

Training

Staff training is a cost-effective means of implementing facility- or system-wide compliance with health care regulatory requirements. At Cooper & Riesterer, we offer training to providers, providers’ employees, or, for larger organizations, staff members who will act as employee trainers. We provide training on a wide variety of recurrent issues, including developing a compliance plan, coding and billing, and HIPAA compliance, as well as training programs tailored to specific emerging issues and regulations affecting the healthcare industry.

Contact us today to learn more about how we can help you with your healthcare-related needs.

Initial Organization: We help our clients get off on the right foot with their new ventures by addressing a wide range of start-up issues including:

  • Selecting the appropriate organizational structure (limited liability company, corporation, joint venture, sole proprietorships, etc. Cetera)
  • Advising on tax matters where appropriate and coordinating with tax professionals to create a structure that will maximize tax benefits during start-up and during the life of the entity;
  • Helping with capital needs, including assessing those needs and helping locate funding sources and options when needed;
  • Creating all required initial documentation including Shareholder Agreements or Operating Agreements to clarify the rights of all participants and ensure everyone is on the same page from the start.

Governance: Business entities are set up to enhance the efficiency of your business and to minimize your personal liability. As you conduct your business, questions and issues are going to arise. We are here to answer those questions and address those issues, to ensure you do not make a misstep that will undo the protections you created for yourself when you set up your organization. We will be there for your business to provide ongoing services, including:

  • Reviewing and monitoring the ongoing structural health of your organization to ensure all documents and policies are up to date and, in place where needed;
  • Addressing Officer / Director governance and liability concerns;
  • Answering ongoing business questions as they arise;
  • Drafting documentation required for new or exiting partners; and
  • Assisting with restructuring and reorganizing entities when needed and drafting required documentation.

Succession Planning: As part of our goal to assist businesses with their goals and plans it is critical for every business to keep their ultimate end game or transition plan in sight, even if it is several years down the road. There are many steps a business owner can take over several years of business ownership that can facilitate a transfer that simply cannot be done within a month or two when the owner decides it is time to sell, dissolve or transfer a business. The best succession planning begins years before an anticipated transition. We understand the steps that can be taken and can work with you to ensure your business is structured properly so that you can maximize your goals when you are ready to transition. As examples, those transitions could include:

  • Buy-sell agreements with third parties, business partners or employees;
  • A merger with or acquisition by a competitor;
  • Estate-related business succession plans to transition ownership to family members; or
  • A business dissolution

Healthcare Compliance

HIPAA Privacy and Security Matters

In the electronic health records era, providers face constant and ever-changing compliance issues in operations and transactions every day. At Cooper & Riesterer, we provide solutions to the regulatory challenges faced by healthcare providers and business associates of covered entities by developing compliance policies and procedures, contracts, and work force training programs.

Compliance Programs and Compliance Audits

Federal and state regulations affect nearly every aspect of healthcare business. The healthcare attorneys at Cooper & Riesterer stay abreast of the most recent changes in the complicated regulatory landscape so that we can provide invaluable counsel to healthcare businesses and individual providers on the impact of any these regulations on their existing business, proposed business purchase, contractual relationship, joint venture, or internal process. Our attorneys also assist health care providers in developing effective compliance programs involving practical policies and procedures and provide continuing education so providers can meet the requirements of the numerous regulations that impact the healthcare industry. We also offer compliance audits to help providers self-identify and correct deficiencies before an outside auditor can do so.

Stark, Anti-Kickback, and Fraud and Abuse

At Cooper & Riesterer, we help providers navigate through the myriad of federal and state regulations affecting entrepreneurial and established healthcare businesses, including the federal physician self-referral prohibition (commonly known as the Stark law), federal Anti-Kickback statute, and state fraud and abuse statutes, as well as other related issues, such as corporate practice of medicine prohibitions and Medicare conditions of participation and billing rules. Health care providers and businesses must be aware of the limits on health care business ownership imposed by the corporate practice of medicine restrictions maintained by many states, as well as the existence of provider-specific Medicare rules that can cause providers to inadvertently violate the law.

Whether you are addressing these issues as part of the due diligence required during formation of a new business or entering into a joint venture or whether you have a specific concern about an existing entity or practice, the experienced attorneys of Cooper & Riesterer can help you understand and comply with these complex regulations.

Audits and Reimbursements

Third Party Payor Audits

Healthcare providers and suppliers are facing an increasing level of scrutiny and auditing activity. The healthcare attorneys at Cooper & Riesterer have significant experience defending Medicare, Medicaid, and other third party payor audits on behalf of healthcare entities, providers, and suppliers nationwide. We also provide consulting services on the audit process to providers who wish to handle third party payor audit appeals in-house to improve efficiency and effectiveness, as well as lower the costs of defending routine audits.

Billing, Payment, and Reimbursement Issues

Our attorneys are well-versed in the latest in the areas in the healthcare industry that impact provider billing and payment practices, including health care fraud and abuse laws, potential false claims, relationships with third party payors, including Medicaid, Medicare, and others. Our experience allows us to help providers be proactive in identifying potential problems with billing practices and to remain compliant with regulatory standards. In the ever-changing health care regulatory landscape, the attorneys at Cooper & Riesterer help their health care clients save resources that would otherwise be expended needlessly to defend against the fallout of poor billing practices, such as audits and false claims investigations.

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