Health Care Business and Regulatory
At Thompson Coe, we offer broad experience in health care business, compliance, and regulatory matters. This includes serving as outside general counsel for many health care providers and their practices. We have represented many provider types with matters ranging from business licensure and accreditation to government audits and investigations. With this comprehensive approach, we advise hospitals, physician groups, home health, hospice, pharmacy, durable medical equipment (DME) manufacturers and suppliers, and other types of health systems on a wide variety of litigation and transactional matters.
Licensure and Accreditation
Thompson Coe health care defense attorneys are available to represent hospitals, physicians and physician groups, pharmacies, home health groups, hospice, and laboratories in licensing and accreditation matters. We offer our healthcare clients a turn-key solution to starting or expanding their healthcare businesses. This includes entity formation, state and federal licensing, and payor accreditation.
Additionally, we have assisted clients in Medicare, Medicaid, and Tricare certification, including preparation for surveys and reviews by accreditation groups such as The Joint Commission (TJC) and DNV Healthcare (DNV). Following initial formation, our attorneys can create compliant policies and procedures to maintain our clients’ certification, licensure and accreditation.
We have counseled clients through Medicare suspensions and revocations, license denials, and alleged deficiencies following an audit or survey. We are experienced in developing acceptable corrective action plans and can provide ongoing advice concerning compliance with licensing and accreditation standards.
Hospital and Physician Contracts
Frequent changes in health care regulations have created uncertainty, particularly when it comes to physician reimbursement models. We advise clients on how to align hospital and physician interests, and draft contracts, in a manner that makes both financial and regulatory sense by focusing on quality metrics and Anti-Kickback Statute (AKS) / Stark Law exceptions and safe harbors. Our attorneys also advise clients on hospital and physician co-management agreements.
Our Areas of Focus include:
- Fair market value
- Profit sharing
- Fee for Service models
- Value-based compensation
- Quality metrics
- Management contracts
- Joint ventures
- Accountable Care Organizations (ACOs)
Health Care Financing
At Thompson Coe, we recognize that health care providers are uniquely affected by the rising cost of supplies, equipment, and professional staffing. Our attorneys can audit a provider’s financial health and suggest or connect our clients with potential public and private financing resources.
Many of our clients operate health care businesses that are active 24 hours a day, 7 days a week, and cannot afford to leave any financing option unexplored. Accordingly, our attorneys take great pride in finding innovative ways for providers to avail themselves of public and private financing options to help build their business and maintain a positive bottom line.
At Thompson Coe, we understand how to negotiate favorable payor contracts for providers seeking to improve their current reimbursement models. We have assisted clients in reviewing and negotiating contracts with BlueCross BlueShield, United Healthcare, Aetna, Cigna, Molina Healthcare, and many other health insurers.
Mergers and Acquisitions
At Thompson Coe, we recognize the importance of developing synergies between healthcare providers. Our attorneys are available to provide mergers and acquisitions advice to a variety of clients within the healthcare industry, including, small to large health systems, private equity and venture capital groups that are invested in or entering the healthcare market, hospital systems, healthcare real estate investment groups, and physician groups.
Each year, the Department of Justice collects more in restitution damages from health care businesses and providers than any other single industry. This consistent trend reflects the government’s strict and growing enforcement against what it perceives as healthcare provider fraud and abuse.
Both large and small health care providers, such as hospitals, physician groups, imaging centers, home health, hospice, pharmaceutical and medical device companies, and laboratories are frequent targets of government investigations. These investigations may come from the U.S. Attorney’s Office, FBI, OIG, Medicare Fraud Control Unit (MFCU), the Texas Medical Board, Health and Human Services Commission, ZPIC and RAC auditors such as Health Integrity, or other investigative groups.
Our attorneys have experience helping health care clients respond to and navigate these often highly intrusive investigations. Health care fraud and abuse laws can impose both civil and criminal liability on individuals and entities. Accordingly, experienced and knowledgeable legal representation is crucial.
Our Areas of Focus include:
- Anti-Kickback Statute
- Stark Law
- Compliance Audits and Training
- False Claims Act
- Qui Tam / Whistleblower actions
- Civil Investigative Demands
- Peer Review
- Investigative Subpoenas
Thompson Coe attorneys work closely with our healthcare clients to understand their business practices and objectives. This allows us to provide cost-effective legal advice to manage and improve our healthcare clients’ day-to-day operations.
Our healthcare general counsel services can be available on a monthly flat fee basis and includes services that are tailored to meet our clients’ needs, such as:
- Revenue cycle management
- Health insurance claim appeals
- Balance billing (including out-of-network)
- Negotiating, reviewing, and drafting physician and vendor contracts
- Hospital lease negotiation and management
- Employment matters
- Managing corporate governance (including attending board meetings and drafting minutes)
- Drafting and maintaining policies and procedures
- Risk management
- Public relations
- Coordinating quality assurance
- Internal and external audits and investigations
- General legal advice and strategic planning
- HIPAA Compliance
- Comprehensive compliance program