Hedy Silver Rubinger

Partner

Fax: 404.873.8725

Biography

Hedy is a partner and chair of the Healthcare Practice. She also serves on the firm’s Executive Committee.

Hedy’s practice focuses on the representation of healthcare providers including nursing homes, ambulatory surgery centers, assisted living facilities, physician groups, continuing care retirement communities, hospitals, home health agencies, hospices, healthcare IT companies, and ancillary service providers. She counsels clients on issues related to operations, regulatory compliance, certificates of need, managed care, reimbursement, change of ownership, and employment. She also represents domestic and foreign private equity investors in health care, REITs and other investors in health care real estate, developers of health care facilities, management companies, and lenders and has extensive experience in managing the regulatory aspects of healthcare transactions, ranging from single-facility purchases and sales to some of the largest multi-state, multiple service-line transactions.

Hedy formed the Regulatory Healthcare Transactions (RHT) team to provide counsel for all regulatory aspects of health care transactions. The RHT team is actively engaged in federal and state regulatory processes and regularly interacts with regulators to help clients efficiently accomplish their business goals.

Hedy has been appointed by the Department of Community Health, Division of Health Planning, to serve on a technical advisory committee charged with recommending changes to the inpatient healthcare delivery system. Through Hedy’s diligent work with her healthcare clients, Arnall Golden Gregory was recognized for accomplishments in delivering transformational client experiences at the fifth annual Client Advisor Awards in the “Large Professional Services Firm” category. She is also a frequent author and lecturer on issues relating to healthcare providers. Hedy has recently served as a contributing author for the Fifty State Survey of Certificate of Need and Licensure: Nursing Homes, Assisted Living, Home Health, and Hospice (American Health Lawyers Association, 2009) and the Healthcare Reform Law Resource Guide (American Health Lawyers Association, 2010).

Experience

  • Advised a leading owner-operator of integrated senior healthcare campuses in multiple facility refinancings (including with HUD) in a number of states, including Indiana, Kentucky, Michigan, and Ohio. AGG assisted with determining any filing requirements for the refinancings, the compilation of filings, and the opinion-writing process for the many facilities, including nursing facilities, assisted living facilities, residential care facilities, and homes for the aged.

  • Advised a large pharmacy operator in its acquisition of more than 20 Missouri pharmacies out of bankruptcy. In order to effect the acquisition, AGG handled preparation of transaction documents, filings, and interactions with the U.S. Drug Enforcement Administration, Centers for Medicare and Medicaid Services, State Board of Pharmacy, and the State Medicaid Agency. AGG also reviewed the purchase agreement from both a healthcare regulatory and FDA-perspective.

  • Represented a healthcare operator in its acquisition of a Georgia continuing care retirement community (CCRC) and provided transaction support, including limited diligence, the filing of certificate of need, Medicare, Medicaid, and multiple licensure applications, as well as ancillary license applications, structuring advice, and negotiated regulatory components of the underlying deal documents. The CCRC had a skilled nursing facility, assisted living community, personal care home, and independent living component and was regulated by both the Georgia Department of Community Health and Office of Insurance and Safety Fire Commissioner. The transaction required a unique focus on the nursing facility’s certificate of need, which was initially obtained in the 1990s during changing certificate of need requirements. The client ultimately received a favorable determination from the Georgia CON agency and closed the transaction on its originally scheduled closing date.

  • Assisted a national REIT in its minority investment in a portfolio of a variety of healthcare providers, including assisted living, memory care, hospice, and private-pay in-home care. The providers were located in multiple states, including Arizona, California, Illinois, Texas, Utah, Washington, and Wisconsin. AGG’s involvement included in-depth diligence, including a review of the providers’ licenses, permits, certifications, and accreditations, PEPPER reports, government investigations and surveys, hospice cap calculations, compliance program, background screening, HIPAA, medical directorships, admission agreements, commercial payor audits, and corporate practice of medicine. AGG also assisted with preparing the underlying investment agreement and related disclosure schedules.

  • Represented a longstanding long-term care provider in its sale of over 50 facilities, which included skilled nursing, assisted living, and independent living facilities in 11 states, including Florida, Georgia, Louisiana, Maryland, New Jersey, New York, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia. AGG prepared all filings associated with the stock transfer of the providers, including all pre- and post-closing filings, and advised on regulatory components of the deal document. The transaction was valued at over $400 million.

  • AGG advised on an asset transaction for a skilled nursing facility operator which operates senior-care facilities in several small Georgia communities. Because the transaction involved a hospital authority owner of the real estate, AGG handled the filing of a full certificate-of-need application, a 60-day process that requires gathering a significant amount of information and data.

  • Advised Griffin-American Healthcare REIT III, Inc. and NorthStar Healthcare Income, Inc. in their $1.125 billion joint-venture acquisition of controlling interest in Trilogy Investors LLC, the parent company of Trilogy Health Services LLC, a leading owner-operator of integrated senior healthcare campuses, operating approximately 100 properties comprised of more than 10,000 beds throughout Indiana, Ohio, Michigan and Kentucky.

  • Represented a publicly traded REIT in a $4 billion sale of a portfolio of senior housing facilities.

  • Assisting with regulatory filings for national provider of provider of short-term post-acute, rehabilitation, skilled nursing and long-term care services.

  • Represented a national provider of long-term care services in a multi-state corporate restructuring and $2.4 billion sale of its national real estate assets. AGG advised on all healthcare regulatory aspects of the transaction and obtained all necessary federal and state agency approvals to close the deal. AGG continues to advise on all health care regulatory aspects of the reorganization and obtain all regulatory approvals necessary to proceed.

  • Advised a longstanding private equity client on all regulatory aspects of a consensual receivership with three different operating companies in 8 states. AGG oversaw the transition of the facilities to new operators during the receivership. The affected facilities were located in Wisconsin, Minnesota, Idaho, Oregon, Washington, West Virginia, Delaware and Pennsylvania.

  • Assisted in the expedited sale of Midwest-based ambulance provider.

  • Assisted in the restructuring of multi-state hospice provider to streamline operations and government reimbursement.

  • Implemented an interim management agreement structure for a client seeking to expeditiously exit a state.

  • Obtained Certificate of Need approval and initial licensure and Medicaid enrollment of one of the nation’s first assisted living projects funded with affordable housing tax credits.

  • Obtained reenrollment and negotiated enhanced reimbursement rates for a multi-state nursing facility provider emerging from bankruptcy.

  • Obtained regulatory approval for the replacement of a nursing facility operator on an expedited timeline on behalf of a REIT (accomplished in three weeks with a typical state timeline of three months).

Credentials

  • Columbia Law School, Juris Doctor — 1989
  • The University of Texas, Bachelor of Arts — 1985,

    With Highest Honors

    • Phi Beta Kappa
    • Health Law Partnership Advisory Council (immediate past Chair)
    • American College of Healthcare Executives
    • American Bar Association—Section of Health Litigation, Health Law Committee
    • American Bar Association Long-Term Care Task Force, Vice Chair
    • American Health Lawyers Association
    • Georgia Academy of Health Care Attorneys
    • State Bar of Georgia
    • Women Healthcare Executives (past President)

Recognition

  • Best Lawyers in America (Elder (Long-Term Care) Law and Health Care Law), 2011–20
  • Georgia Super Lawyers (Health Care, Administrative Law), 2004–19
  • “Top 50 Female Lawyers,” Georgia Super Lawyers, 2012
  • “Legal Elite,” Georgia Trend, 2012
  • Georgia’s Top Rated Lawyers, LexisNexis Martindale-Hubbell, 2012
  • Chambers USA: America’s Leading Lawyers for Business (Healthcare), 2009–11, 2013-19
  • Recipient of Client Advisor Award (Large Professional Services Firm Category), 2010

News & Insights