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The firm's Health Law Practice Group provides both corporate and regulatory
representation to health industry clients, including specialized representation
in regulatory and reimbursement matters, administrative litigation and
litigation in state and federal courts. Areas of the health law practice
of the firm include joint ventures, mergers and acquisitions; integrated
delivery systems; health maintenance organizations and other managed care
plans; Medicare/Medicaid reimbursement and compliance including Stark
Bill and anti-Kickback Statute compliance; EMTALA compliance; licensure
and medical staff issues; certificates of need; hospital/physician affiliations;
and other issues unique to health care delivery systems.
Corporate The firm's Health Law Practice Group has served as counsel on a number of local, regional, and statewide physician hospital organization ("PHO") and network PHO projects throughout the Southeast, whose primary focus is managed care. The Health Law Practice Group has established fully integrated delivery systems among hospital system clients and major group practices and has also prepared the various contracts and documents used to establish heart institutes at several hospitals. Also, the Health Law Practice Group has worked with preferred provider organizations and health care providers to develop national, regional, and local cardiac care networks and programs. A principal focus of the health law practice has been the structuring and implementation of acquisitions and mergers, joint ventures, integrated delivery systems, and restructurings for numerous public and private not-for-profit hospitals and multi-institutional systems. Additionally, the Health Law Practice Group has been involved in negotiating, both from the seller's perspective and the buyer's perspective, numerous acquisitions of physician practices. The pace of transactional work for the firm's clients has accelerated in recent years as the health care industry has been consolidating in response to managed care and health reform initiatives. These activities often bring together all disciplines of the firm, including lawyers specializing in tax, antitrust, insurance, health planning, licensure, rate regulation, and reimbursement, as well as the corporate practice team. The Health Law Practice Group provides lawyers experienced in various facets of tax planning and controversies for health care organizations. Members of the team have represented numerous tax-exempt organizations, including major medical teaching institutions, community-based hospitals, and medical and research foundations in seeking rulings and in unrelated business income controversies, at all levels of the Internal Revenue Service. Other matters handled for such organizations have included sales and use tax and ad valorem tax issues. Growing pressures from federal, state, and local taxing authorities to subject private, not-for-profit hospitals and related entities to taxation have been a recent source of major growth in the firm's counseling activities, and are expected to be a source of considerable litigation in the future, as local controversies in other areas of the nation spread into the South, and the federal government intensifies its activities in this area. The health care industry has been the most fertile source of federal antitrust activity since the early 1980's, and the Health Law Practice Group includes lawyers specializing in antitrust matters affecting the health care industry. Antitrust concerns arise in the context of acquisitions, mergers, and joint ventures; PPO's, PHO's, and managed care plans; medical staff disputes; and health planning. The firm has represented clients in each of these areas throughout the Southeast, both in counseling and in complex litigation. Regulatory The Health Law Practice Group's Medicare/Medicaid reimbursement practice is national in scope, with client representations from coast to coast. The Health Law Practice Group has represented numerous clients at the administrative level in audits, validation reviews, and settlement negotiations with HCFA, Part A intermediaries, Part B carriers, and state Medicaid agencies; in pursuing Freedom of Information Act Requests; and in controversies before the PRRB, administrative law judges, and fair hearing officers. The group has also handled substantial reimbursement litigation in federal trial and appellate courts, as well as Medicare certification/decertification and EMTALA enforcement actions. The Health Law Practice Group also regularly assists clients in developing and operating regulatory compliance programs and in responding to criminal and civil investigations. This area has become a particularly important part of our firm's health care practice during the past several years. Members of the Health Law Practice Group have represented a variety of providers in civil and criminal investigations brought by federal and state regulators, including federal enforcement initiatives brought by the Office of Inspector General of the Department of Health and Human Services and the Department of Justice. The firm has also represented and advised providers in connection with False Claims Act litigation, including qui tam cases. In connection with these matters, members of the Health Law Practice Group have conducted internal investigations and managed voluntary disclosures to various enforcement agencies. The Health Law Practice Group has represented hospitals and long term care providers in a variety of licensure matters. Frequently, licensure issues arise in connection with acquisitions, construction projects, and restructurings undertaken by clients of the firm. Licensure laws in many states for home health agencies have also been a source of controversies handled by the firm. Members of the Health Law Practice Group have counseled with clients on certificate of need matters throughout the South and in other states. The firm has considerable experience in working with health planning agencies and in administrative litigation and judicial appeals of health planning controversies. The firm has litigated hundreds of certificate of need matters involving virtually every type of regulated project and service and has frequently secured reversals of initial health planning agency actions. Insurance regulation in Georgia and Florida is also a focus of the
firm's health law practice. The firm has represented numerous health
care systems in forming HMO's and PSHCC's, and it has represented clients
in major regulatory disputes with insurance departments. Among these
matters, the firm represented the founding hospital members of the first
statewide HMO in Georgia.
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