Healthcare Regulatory
At the core of the Healthcare Industry Practice Group is our Healthcare Regulatory Group comprised of 23 attorneys dedicated to serving the firm’s healthcare clients. There are 13 partners and 10 associates working in client teams to deliver superior client service in all industry sectors in the following four focus areas:
Mergers, Acquisitions and Dispositions
We have represented clients including hospitals, health systems, academic medical centers, and community-based and government-owned hospitals in hundreds of healthcare M&A transactions. The healthcare industry provides unique challenges in the areas of due diligence and the evaluation of potential risks and liabilities. A keen sensitivity to fraud and abuse issues is mandated. The experience Bass, Berry & Sims has developed through the large number of providers, payers and other healthcare-related companies we serve is critical to the representation of our clients in these types of transactions. Representing providers and non-providers in healthcare M&A transactions requires a thorough understanding of the legal and regulatory constraints affecting the healthcare industry.
Joint Ventures and Syndications
We have extensive experience in joint ventures, syndications and private placements of securities involving hospital systems, long-term care facilities, outpatient service providers, ancillary service providers, independent practice associations, managed care organizations and health information and technology entities. Our engagements feature thorough due diligence reviews to uncover potential regulatory exposure associated with acquired entities or joint venture partners. Our experience has provided us the opportunity to work with many investment bankers and equity and debt financing sources throughout the country.
Contracting, Regulatory and Operational Matters
Our attorneys handle a multitude of critical healthcare regulatory and operational issues, including self-referral prohibitions, fraud and abuse analysis, licensure, certification and accreditation for healthcare facilities, certificates of need, corporate compliance programs, managed care contracting, group purchasing arrangements, HIPAA compliance and Medicare, Medicaid and third-party payer reimbursement matters. Our experience includes specialty services such as hospitalist programs, disease management and the difficult issues surrounding physician recruitment. We have advised many clients on the rapidly evolving and complex set of laws involving physician self-referral and fraud and abuse restrictions in order to structure transactions, joint ventures and other financial relationships to comply with federal and state laws, including those related to the corporate practice of medicine and fee splitting. We regularly assist clients with traditional operational requirements applicable to healthcare facilities, such as medical staff bylaws, staff privileges and professional liability. We also handle patient care issues involving advance directives, confidentiality, EMTALA transfers, informed consent and anti-discrimination and accessibility laws.
Government Investigations, Enforcement and Compliance
We have represented healthcare clients in connection with internal investigations regarding potential regulatory, compliance and clinical issues. Our experience includes representing clients in investigations conducted by the Office of Inspector General, United States Department of Justice, the Centers for Disease Control and Prevention, and state regulatory agencies.
Government audits of healthcare providers continue to increase in frequency and to evolve in nature and scope. Because of the serious consequences that can result from an audit, seeking outside legal experience before responding is advisable. Bass, Berry & Sims PLC has significant experience representing clients in all types of audits, as well as in developing policies in anticipation of an audit. At the outset of an audit, the firm can assist clients in responding to a request for medical records by advising on the appropriate documentation needed to support claims or helping prepare for interviews conducted by auditors. In cases where an overpayment demand is received by the provider, Bass, Berry & Sims PLC can assemble the coding professionals, statistical experts, and independent medical experts necessary to formulate an appropriate response.
We frequently work with clients in developing and implementing compliance programs and providing advice on compliance-related matters. We work with clients to develop policies in anticipation of government and commercial payer claims audits. These audits include those performed by Recovery Audit Contractors (RACs), Program Safeguard Contractors (PSCs), now known as Zone Program Integrity Contractors (ZPICs), and Medicaid Integrity Contractors (MICs). We routinely represent clients in responding to claims audits and in the appeals of audit results. This group counsels clients in antitrust regulatory requirements, corporate compliance programs and internal and government investigations.
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