OVERVIEW
The Healthcare Group has a well-earned reputation for handling high-stakes, high-risk cases, including complex medical malpractice litigation and professional liability claims. The group also provides general representation and counseling in various areas of healthcare law, including administrative and court proceedings involving licensure issues, staff privileges and credentialing, contracts for the exclusive provision of services, and potential antitrust implications. We have experience handling Medicare and Medicaid fraud cases and assisting clients in responding to compliance audits in civil and criminal investigations which may arise in defending malpractice claims.
Many of the complicated claims that we defend include those against pharmaceutical companies and makers of medical products and devices. We represent both insured and self-insured developers, manufacturers, distributors and patent-holders of pharmaceuticals, over-the-counter medications, prostheses, implants, hospital equipment and diagnostic devices.
We take a holistic approach to healthcare matters to understand not only the case at hand, but its potential implications for the organization. As such, we take pride in understanding a client’s business objectives and provide counsel across a wide-range of healthcare-related matters. Our extensive experience in representing hospitals and healthcare institutions, as well as physicians and allied health professionals, gives us unique perspective on institutional issues, including hospital/medical staff relationships, personnel, privacy and data security, and insurance coverage and risk management. Members of the group also serve as outside general counsel to a variety of diverse health practice groups and hospital networks.
Business and Corporate Transactions
We provide corporate, tax, regulatory and transactional advice on a wide range of business-related matters, including mergers and acquisitions, joint ventures and strategic alliances, debt and equity financings, licensing and outsourcing, IP protection, cybersecurity and data privacy, corporate structure and governance matters and general contract matters. We collaborate with clients to provide strategic solutions to the complex legal and business issues they face, while helping them achieve their business objections.
Our work encompasses acquisition issues, third-party contracts and general contract needs, which have included:
- merger and acquisition agreements
- joint venture and strategic alliance agreements
- shareholders agreements
- employment agreements
- non-compete agreements
- clinical trial agreements
- confidentiality agreements
- independent contractor agreements
- practice management and billing agreements
- technology license and outsourcing agreements
- affiliation agreements
Health Insurance and ERISA
The healthcare industry has been experiencing enormous upheaval for several years. With the passing of the Affordable Care Act, and its uncertain future, the healthcare system had been under extreme pressure to change, with the ripple effect foisting untold duress upon health insurers, plan administrators, employers and providers. Our group has the experience to help clients navigate through this healthcare minefield.
Recent changes in the law, as well as decisions by State and Federal courts, are shifting the way healthcare is being delivered and paid for, which exposes payers to liability, while eroding existing protections. We have extensive experience in representing and counseling health insurers in the establishment of new healthcare networks, out-of-coverage disputes, antitrust claims, Medicare and Medicaid fraud and abuse and compliance under ERISA and other Federal regulations.
We have extensive experience representing and counseling in various areas of healthcare law, including:
- Establishment of new healthcare networks
- Out-of-network coverage disputes
- Healthcare network contractual disputes
- Provider litigation
- Benefit entitlement
- Compliance Issues under ERISA, PPACA, fraud and abuse laws and pertinent regulations
- Healthcare antitrust claims
- Fraud
- Medicare and Medicaid fraud and abuse
- RICO
- HIPAA analysis and implementation
- Coverage issues
- Counseling third-party administrators
- Bad faith
- Breach of fiduciary duty
- Plan interpretation
Labor and Employment
We counsel clients in their role as employers, dealing with all of the regulatory and common law issues that arise in the workplace, including leave policies, progressive discipline policy design and implementation and litigation avoidance. We regularly provide advice regarding bylaws and related corporate documents for healthcare institutions and have drafted medical staff guidelines, rules and regulations, bylaws and similar hospital policies. Our extensive experience in representing hospitals, as well as physicians and allied health professionals, gives us unique experience in terms of institutional issues, including hospital/medical staff relationships, physician group structure, personnel and insurance coverage and risk management issues.
Litigation and Dispute Resolution
The Healthcare Group has a well-earned reputation for handling high-stakes, high-risk cases, including disputes ranging from the effects of tiered and narrow health plans, out-of-network coverage litigation, fraud and abuse claims, HIPAA and privacy matters, professional liability and medical malpractice claims and medical products liability. We have experience handling ERISA claims litigation, healthcare coverage litigation and the administration of health plans, as well as assisting clients in responding to compliance audits in civil and criminal investigations. We also provide general representation and counseling in various areas of healthcare law, including administrative and court proceedings involving licensure issues, staff privileges and credentialing, contracts for the exclusive providing of services, payment disputes and potential antitrust implications.
Whether a case involves a single plaintiff or myriad multi-district parties, we have the strategic focus and attention to detail demanded for successful outcomes. We use a team approach to defending clients in these complex cases, maximizing experience and strengths to provide a thorough, economical defense. The group includes a number of attorneys who have worked as healthcare professionals themselves, which provides an enhanced knowledge base for the representation of our clients. In addition, our appellate lawyers are involved at each stage of the litigation process to provide assistance with developing litigation strategy, drafting dispositive motions, monitoring trials and crafting post-trial motions.
Long-Term Care, Managed Care and Assisted Living
We provide advice and representation for home health agencies and have considerable experience in representing personal and continuing care communities, as well as traditional nursing homes. We are involved with Departments of Insurance, Aging and Health, and other regulatory agencies having jurisdiction over the development and operation of facilities. We assist in the development and implementation of clinical programs, regulatory compliance (State, Federal, JCAHO) and risk management, and, in general, help skilled nursing facilities, assisted living communities, home health companies, active adult communities and independent living communities manage their business, regulatory, employment and litigation needs. Our attorneys take pride in providing creative, aggressive, yet practical and cost effective defense of personal injury litigation.
Regulatory and Compliance
We ensure that our clients are compliant with all federal and multi-state healthcare laws and regulations, including Medicare/Medicaid, HIPAA, the CURES Act, Stark Law, the Anti-Kickback Statute and the False Claims Act, among others. We also represent clients in investigations, audits and litigation or disputes arising from regulatory and compliance issues.
Additionally, we prepare and present emergency medical petitions for court approval, provide advice to hospital administration and staff members concerning HIPAA/CURES Act compliance, DNR orders, AIDS testing, guardianship and similar legal and medical issues.
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Representative Matters
- Represented physician practice group in matter involving information blocking of electronic health records (EHR) by a health information technology vendor and obtained multiple temporary restraining orders maintaining EHR access and a comprehensive plan for migration of EHR data (approximately 100 terabytes) from prior EHR vendor to new EHR vendor
- Represented a privately held medical device development firm in the licensing of a patent-pending drug delivery instrument from a publicly traded pharmaceutical company
- Advised founding physician shareholder in connection with restructuring of diagnostic imaging practice, including recapitalization by private equity investors
- Advised and negotiated employment agreement and practice support agreement in connection with cross country relocation of a surgeon to an existing private practice
- Represented company developing platform for interface among various electronic health record technologies
- Represented company developing digital health mobile application in connection with strategic relationship and ongoing corporate transactional work
- Obtained a published opinion from the New Jersey Appellate Division granting a protective order in a matter wherein several hospitals were seeking intrusive discovery concerning the creation and implementation of a health plan. (Capital Health System Inc., v. Horizon Healthcare Services Inc., NJ App. Div. A-2913-15 (June 23, 2016))
- Successfully argued for the reinstatement of a surgeon in a health network following a credentialing committee’s decision to terminate; presented the appeal to a credentialing committee comprised of multiple physicians from varying specialties; following the presentation, a decision was made to reinstate the surgeon back into the health network
- Obtained a trial verdict in a breach of contract claim brought by a physician against a large healthcare network
- Successful defense on motion to dismiss of medical doctor accused of repeatedly offering fraudulent expert testimony. Dismissal affirmed by Delaware Supreme Court.
- Represented emergency room physician in a case in involving an alleged failure to diagnose bacterial meningitis; tried to a defense verdict after seven days of trial
- Numerous defense verdicts in catastrophic injury cases involving professional, product and premises liability, on behalf of individual providers, health care systems, hospitals and other health care institutions
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