HMBR represents its clients in investigations and/or seeking approval or opinions in front of various state agencies such as department of insurance, certificate of need agencies, state attorneys general and Federal agencies such as the US Department of Justice, Federal Trade Commission, the Internal Revenue Service and the Department of Health and Human Services. The firm’s representation includes practice before CMS and OIG with respect to issues such as Medicare reimbursement, Stark self-disclosures, RACs and other investigations, self-disclosure and whistleblower actions.
Clinical Integration / Accountable Care / Population Health Management:
HMBR has counseled clients extensively in clinical integration matters, and has assisted clients in establishing accountable care organizations through which the independent and employed physicians can develop and implement a clinical integration and accountable care program and engage in joint contracting activities with the government and managed care organizations. The firm has also assisted with the formation of many ACOs under the MSSP Regulation as well as assistance with participation in the Bundled Payment Demonstration Project, Comprehensive Care for Joint Replacement, Pioneer ACOs and Next Generation ACO. The firm also analyzes the compliance of such organizations with other regulatory laws, such as the Medicare Anti-Fraud and Abuse and the Stark law and any waivers by the federal government of the applicability of those laws.
Hospital / Physician / Joint Ventures / Collaborations:
HMBR has developed and assisted in the operation of countless hospital/physician joint ventures, including ambulatory surgery centers, medical office buildings, sleep laboratories, diagnostic imaging facilities and hospital/physician employment. Recently, its practice has focused extensively on co-management agreements, pay-for-performance arrangements, gainsharing and other arrangements to promote quality and efficiency, including the design and implementation of Hospital Quality and Efficiency Projects whereby hospitals recoup some of their investment in accountable care and clinically integrated organizations by rewarding efficiencies when treating hospital patients while preserving or enhancing quality and patient satisfaction.
HMBR has assisted hospitals in collaborating through mergers, asset acquisitions, joint operating agreements and super-parent models. More recently, the firm has assisted hospitals to clinically integrate across service lines in compliance with antitrust laws. The firm is expert in the attendant legal issues related to these transactions, including certificates of need, licensure, change of ownership, tax, Medicare and the other regulatory issues which affect complex transactions. HMBR has received precedent-setting rulings and opinions in these transactions.
HMBR has advised numerous clients regarding the antitrust implications of acquisitions, consolidations, mergers, affiliations and managed care contracting. Most recently, the firm defended a multihospital system and its affiliated physician network against a charge of price fixing brought by a large national health plan. Following a full hearing on the merits, the arbitration panel dismissed all claims against the hospital system and the physician network.
The firm’s attorneys have developed numerous IPAs, PHOs, HMOs, PPOs, Point of Service option plans and specialized risk plans. HMBR has also assisted many of their clients in negotiating innovative payment arrangements, including population health payments and shared savings.
Medicaid Managed Care:
The firm has extensive experience establishing networks to deliver services to the expanded Medicaid population under the Affordable Care Act. For example, it represents the largest managed care community network in a major metropolitan area, and several other provider networks servicing exclusively the Medicaid population, such as seniors with disabilities.
Privacy & Security / EHR:
The firm counsels clients, including publicly-traded companies and providers, regarding legal issues arising with acquisition and use of healthcare information technology, including privacy and security laws. The firm has conducted internal investigations of breaches of protected health information and assisted clients with responding to governmental investigations of alleged violations of HIPAA/HITECH.
Academic Medical Centers:
The firm has advised clients on education-related regulatory matters, including eligibility to participate in the US Department of Education’s Title IV federal student aid program, compliance with standards of accrediting agencies, application of state authorization requirements and preparation for USDOE and accreditation site visits and response to compliance reviews.
The firm reviews various business arrangements for its clients, including purchases and leases of equipment, land and supplies, medical director services, employment, management, construction and other types of service agreements.