The issues involved in creating a healthcare entity are dependent upon the form of entity chosen and the financing available to the business. The attorneys at Blodnick Fazio & Clark can help to analyze each healthcare entity’s individual circumstances in order to determine what financing and formation agreements are right for them. Starting off with the wrong financing, or the wrong formation, can have a serious adverse impact on the business, while additional planning and greater care taken during the formation process can help make the business more successful. Once the healthcare entity is formed and financed correctly, there are a whole host of other issues that the firm can address. Almost every day the work done by healthcare providers is scrutinized to the highest degree. There is a great potential for legal issues that may arise from patients, employees, attorneys or business partners. The attorneys at Blodnick Fazio have represented clients on both sides of healthcare law matters and understand the need for the best representation when faced with difficult health law issues. Below are some of the most common healthcare law matters that the firm has addressed for our clients.
Formation of Healthcare Practices and Other Provider Entities
Forming a healthcare practice is much different from forming any other type of business, as the business is formed with professionals in mind. The formation of a healthcare practice, whether it is to be a partnership, corporation, or any other business model, is a delicate system and upon the formation of the practice, every single issue must be addressed or discussed. The attorneys at Blodnick Fazio & Clark can help to make sure that the entity you decide to form will be the best option for your type of business. Our firm is dedicated and experienced in the area of corporate reorganizations as well as any ownership, structural or employee changes. Furthermore, our attorneys will help to ensure that your business is protected and is not violating Stark regulations as well as fraud and abuse laws. The type of entity to be chosen will depend on individual facts and circumstances and the need to limit liabilities. Our attorneys will help to make sure that your individualized business needs are addressed.
A newly formed, merged, or purchased healthcare entity will succeed or fail depending on proper business planning, financial planning, and profit margins. A skilled business financing attorney can help address current and long-term financial goals. While most businesses are financed institutionally, there are other ways of financing a business that may be better situated for certain businesses. How a healthcare entity chooses to finance their business should be based on a case-by-case analysis of needs. Additionally, business financing attorneys will help to protect individual assets of any person involved in the startup of the company and take steps to ensure that they will not be held personally liable for any debts the healthcare entity may incur.
Employment Agreements for Healthcare Providers and Entities
It is also important when forming an employee and employer relationship to make sure that all terms set forth in employment agreements are precise and unambiguous. There are many employment relationships that may be formed when entering a healthcare practice. Some of these relationships include independent contractors, employees, not to mention equipment leases, space leases, real estate transactions, recruitment agreements, professional service arrangements, relationships with physicians, hospitals, health systems, hospices, home health agencies, physical therapists, nurse practitioners, and long-term care facilities. Our attorneys can assist with the drafting of agreements that protect the interests of the healthcare practice while complying with applicable federal, state, and local laws and regulations.
Credentialing and Audit Issues with Medicare, Medicaid. and Various Health Insurers
Currently, providers and suppliers of services to patients covered by Medicare, Medicaid, and third-party health insurers are being placed under heightened scrutiny and are becoming more likely to be subject to increased audits due to billing issues. The main focus of an audit is to provide evidence that health insurers have been properly billed for any medical service provided to patients. When a health insurer has reported an allegation of overpayment the health care provider will have the opportunity to appeal that allegation. The appeals process for an alleged overpayment can be a stressful and burdensome process. With the help of skilled attorneys, this process can go more smoothly and effectively. When Medicare, Medicaid or private insurers allege improper billing, it is important to be represented by legal counsel throughout the process. READ MORE »
Litigation in State and Federal Courts
During audits of the healthcare provider, it is common that a health insurance entity will file a clawback action against the healthcare provider. Clawback actions are usually brought against healthcare providers by health insurance entities, such as Medicare, Medicaid, or private insurers, when there is a discrepancy over how much a patient is being charged for certain services. Clawback litigation will allow health insurers to seek the return of the funds they have distributed to healthcare providers. For example, Medicaid can claw back funds they disbursed for the care of a patient who is now deceased, or a health insurer can clawback funds disbursed for a patient who now has a canceled insurance policy. Clawback litigation ensues when a provider does not refund the monies when required. Blodnick Fazio attorneys represent healthcare providers in these types of matters. Additionally, our attorneys can assist with drafting clawback agreements that will specifically tailor the obligations of both the health insurance entity and the healthcare provider in order to reduce the likelihood of litigation.
Licensing Issues with the Office of Professional Medical Conduct
License investigations may arise for a variety of different reasons. Some of the most common reasons for licensing to be questioned is patient complaints or complaints from other healthcare providers. While some investigations may be closed quickly due to the allegation of having no merit, some other investigations can be open for a long time until the issue is resolved. Even with complaints that have no merit and seem to have ended quickly, it is important to have counsel present when speaking to any investigators as to protect your rights as well as the rights of your employees and your business.
Sales of Healthcare Practices
Buying or selling a healthcare practice is a unique transaction that comes with its own related laws and obligations. Our attorneys can help this process by drafting purchase agreements, developing management agreements where appropriate and helping to identify practices that may be possible candidates for purchasing or selling. The New York State Department of Health requires the filing of a change of ownership documents and the Centers for Medicare and Medicaid Services will also require their own 855 applications. Our legal team can ensure that you have the proper documentation filed to have a smooth transition during the buying and selling process. Additionally, we can provide assistance in determining the fair market value of your healthcare practice or another healthcare practice you are interested in purchasing.
Partnership, Shareholder and Operating Agreements
Partnership and shareholder disputes are common within the healthcare industry, therefore, having a properly drafted and executed agreement can help to avoid unnecessary difficulties as the practice progresses. Occasionally, the relationships you have with an employee, officer, director, or partner will sour and this can lead to a variety of issues such as the departure or the breakup of physicians in your healthcare business. This sort of turmoil affects everyone involved with the business and can stir up financial, ethical, professional, and emotional issues. While an effective partnership, shareholder or operating agreement is helpful during these uncertain times, it is possible that the agreements formed have not covered every issue, or the agreements have become stale with time. Our attorneys will work with you to ensure potential issues are properly addressed within the relevant agreements. If an issue may arise that is not covered by the agreement, a pre-litigation settlement may be negotiated in order to reach an amicable resolution.