Healthcare Regulatory Reimbursement Counsel

Overview

Healthcare providers and companies turn to Parker Hudson for strategic counseling, compliance guidance, and experienced and effective representation in regulatory and reimbursement matters. We offer practical guidance in understanding and navigating the maze of complex operational and regulatory issues that providers face.

Healthcare companies face a multitude of challenges regarding their compliance and regulatory obligations. Our team is here to resolve those uncertainties, advance our clients’ interests, help them navigate or avoid audits, and provide forward-looking legal counseling at every turn.

We assist with licensure, regulatory approvals, certificate of need, and other operational issues critical to healthcare providers. In addition, we have years of experience representing clients in reimbursement and compliance matters, with several of our attorneys having experience working in the healthcare compliance field. Our legal services are informed by a practical understanding of the clinical and professional realities of healthcare operational issues.

Advised multiple providers regarding regulatory matters, including compliance issues, investigations and voluntary refunds.
Advise leading health information exchange regarding regulatory and operational issues, including HIPAA Privacy and Security compliance.
Successfully secured multi-million dollar reimbursements for providers for newly approved drug.
Conducted regional and national training programs for covered entities, business associates and other clients regarding HIPAA Privacy and Security Standards. Regularly advise clients regarding breaches, privacy audits and investigations by the Office of Civil Rights.
Provide due diligence compliance and regulatory support to healthcare lending clients.
Represented a tax exempt physician practice with the highest patient volume in the country in its subspecialty with respect to federal and state regulatory approvals, compliance and joint venture/affiliations.
Represented client with respect to acquisition of interest in a cancer center joint venture.
Assist client with respect to acquisition of dermatology practice.
Served as lead counsel for hospital system in Provider Reimbursement Review Board appeal seeking substantial additional Medicare reimbursement for allowable Medicare bad debt.
Served as lead for hospital system in Provider Reimbursement Review Board appeal seeking substantial additional Medicare reimbursement for allowable Medicare disproportionate share of Hospital payments.

Represent Hospital in litigation challenging the Florida Agency for Healthcare Administration's published Medicaid outpatient payment rate.
Serve as lead counsel for hospital system in appeal of Zone Program Integrity Contractor audit and overpayment determination.
Served as lead counsel for health system in connection with American Arbitration Association arbitration dispute with managed care payor alleging wrongful denials of payment for home health services.
Served as lead counsel in American Arbitration Association arbitration dispute with Medicare Advantage Management Care payor challenging reduced payment associated with Medicare sequestration reduction.
Represented providers (hospitals, physicians, home health agencies, hospice and skilled nursing facilities) in Medicare contractor audits and appeals, including successfully reversing statistical extrapolations.
Served as lead counsel in representation of Hospital seeking Georgia CON approval for multi-specialty ambulatory surgery center and cancer center offering radiation therapy services.
Represent hospital system in response to EMTALA complaint and investigation. Representation included submission of acceptable Plan of Correction of cited deficiencies and response to CMS termination action and potential OIG action.
Developed and executed a regulatory system strategy for St. Joseph's/Candler related to development of micro hospital campus in western Chatham County.
Developed and executed an acquisition regulation and legislation strategy for Northeast Georgia Health System related to acquisition of assets of Chestatee Regional Medical Center and subsequent sale and lease back to Georgia Board of Regents (the State University System).
Advised Georgia Alliance of Community Hospitals regarding development of legislative strategy for 2019 session of Georgia General Assembly.
Represented Navicent flagship hospital in connection with a regulatory appeal instituted by a competing hospital regarding Navicent's authority to operate a hospital outpatient imaging center. Successfully obtained a ruling from the Georgia Court of Appeals overturning a decision of the Monroe County Superior Court and affirming Navient's regulatory authority to operate the center.
Helped Floyd Medical Center obtain designation from the Georgia Department of Behavioral Health as an official emergency receiving evaluation treatment facility.
Represented Veritas Collaborative, LLC obtain regulatory approval for the first dedicated pediatric eating disorders 50-bed inpatient hospital in Georgia. We obtained approval despite the fact that four existing inpatient psychiatric systems initially opposed the program and that no new psychiatric hospital had been approved in Fulton County, Georgia in many years.
Obtained CON approval for the development of new a hospital emergency department for Columbus Regional Health Northside Hospital. Representation included obtaining a final agency decision after an administrative trial and subsequent appeal to agency commissioner by competing health care system. We were also able to obtain a ruling that the client hospital be considered a general, not specialty hospital. That ruling enabled hospital to expand their range of services in the future.
Advised a regional Hospital regarding CMS, licensure, and CON strategies related to proposal to acquire and replace an existing hospital and develop/provide various outpatient services during replacement process. Our attorneys met with governmental officials (including agency head) to explain and advocate for regulatory strategies.
Obtained a joint licensure and CMS certification for new South Hall Campus hospital facility to be treated as part of a single Northeast Georgia Medical Center provider entity.

Thought Leadership

Bob Brennan, Tracy Field, Stefan Grow and Tara Ravi featured in "Agility and Speed Disrupting the Future of Health Law," American Health Law Association docuseries "Health Law Disruption: 2030 and Beyond" (October 22, 2020)