Hospitals & Health Systems

Overview

Our attorneys advise hospitals and health systems, including academic medical centers, on a wide range of legal issues. We assist hospitals in matters concerning reimbursement, including pursuing claims in administrative and judicial proceedings and advising as to rules and regulations governing reimbursement, such as those promulgated by the Centers for Medicare and Medicaid Services (CMS). We have substantial experience in representing hospitals in government audits and investigations and in dealing with complex self-disclosure issues.

We also counsel hospitals on a wide range of healthcare transactions, including mergers, hospital acquisitions, medical practice acquisitions, physician recruitment, provider joint ventures, physician co-management arrangements, and managed care contracting, including how to structure such transactions for compliance with complex state and federal laws and regulations affecting the healthcare industry.

We assist in obtaining certificates of need for hospital projects and determinations as to whether such projects are subject to such state review. We are uniquely experienced in representing hospitals in real estate transactions.

We advise hospitals on compliance issues, including the development and implementation of individually tailored compliance programs. We provide counsel on medical staff issues and corrective actions. We also advise hospitals and health systems with respect to tax-exemption and antitrust issues. Our attorneys have published and lectured extensively on matters impacting hospitals and health systems.

Experience

  • Provided antitrust analysis and advice with respect to joint affiliation and clinical integration agreement.

  • Represented a large regional health system in the corporate restructure of its operations from a Georgia Hospital Authority operated hospital to a restructured, tax exempt not for profit hospital.

  • Provided strategic advice on potential affiliations, including antitrust analysis.

  • Represented one of the largest health systems in the Southeast in an investigation by the Department of Justice into an allegation of discrimination against a patient with mobility disabilities.

  • Lead counsel representing several employee benefit plans, third-party administrators and service providers in two lawsuits brought in Nebraska regarding whether PPO networks apply to claims submitted by multiple provider hospitals.

  • Represented a large health system in the development and negotiation of clinical trial program agreements.

  • Represented a national pain management company address state and federal regulatory matters related to acquisitions and subsequent corporate reorganization.

  • Advised a preeminent national healthcare provider in providing guidance to directors and officers in negotiations over the withdrawal of financial assistance to a Georgia rural hospital.

  • Represented a large hospital system in the development of a professional services agreement for the development and offering of general surgery services.

  • Advised a Georgia Hospital Authority regarding its restructuring under the Georgia Hospital Authorities Law.

  • Evaluated termination of Chief Executive Officer.

  • Represented a large hospital system in the development of a regional urgent care joint venture arrangement, including tax strategy, corporate structure and regulatory analysis.

  • Request for reconsideration of denial of Medicare enrollment of physician with felony.

  • Represented a large regional health system in the acquisition of a privately held, joint venture ancillary service provider.

  • Stark law analysis of compensation model for senior physician leadership

  • Represented a large hospital system in the development of a single specialty (hospital-physician) joint venture ambulatory surgery center.

  • Assistance in structuring 15-year agreement with imaging equipment vendor and seeking OI6 advisory opinion in light of discount and risk components of arrangement.

  • Represented a large single specialty physician group in the addition of new shareholders in both the main practice and ancillary lines of business.

  • Represented a single specialty surgery center in the negotiation, diligence, fraud and abuse counseling, and drafting of joint venture with a large regional health system.

  • Represented a national subspecialty services provider and management company in the analysis of related fraud and abuse issues.

  • Defended indemnity claim by a SNF based on settlement of a False Claims Act claim by the United States Government involving rehabilitation services.

  • Represented a national subspecialty services provider and management company in its corporate reorganization and national development.

  • Structuring contracts and policies for 24×7 staffing of ICU with intensivist physicians.

  • Represented a national subspecialty services provider and management company in the acquisition of related providers.

  • Defend lawsuit by borrower and a financial institution seeking to enjoin foreclosure on collateral for a $20 million note.

  • Assisted a large regional hospital system in the development and negotiation of an exclusive provider agreement for hospital based services.

  • Defend lawsuit by borrower and a financial institution seeking to enjoin foreclosure on collateral for a $20 million note.

  • Represented a national subspecialty services provider and management company in the development, fraud and abuse counseling, and negotiation of national service line management program and related exclusive service provider agreements.

  • Represented a community hospital in the development and negotiation of an emergency room staffing agreement.

  • Represented a community hospital in the development and negotiation of a hospitalist agreement.

  • Obtained Order dismissing Heritage Healthcare of Ashburn from multi-party litigation based on the Plaintiff’s failure to arbitrate claims of negligence as required under a valid and enforceable arbitration agreement.

  • Successfully defended Health Management Associates at trial from claims that it breached the terms of an employment contract with a former employee.

  • Represented a large hospital system in the development of a system-wide, multi-specialty, physician practice acquisition strategy and process; including all documentation and negotiation.

  • Represented a large regional hospital system in the development of a professional services arrangement, including all aspects of the transaction, including due diligence, negotiation of primary agreements, regulatory filings (state and federal).

  • Represented, as part of an AGG team, a national long-term care hospital chain in Medicare reimbursement appeals stemming from a Centers for Medicare and Medicaid Services (CMS) post-payment audit demonstration project. The AGG team achieved fully favorable ALJ decisions for the provider in more than 95 percent of cases tried during the three-year demonstration project.

  • Represented a group practice in the negotiation, diligence, fraud and abuse counseling, and drafting of a professional services agreement with a large regional health system.

  • Successfully represented a Georgia home health provider in a request for reconsideration of a CMS contractor’s decision to terminate the provider’s Medicare enrollment.

  • Represented a large hospital system in the negotiation and drafting of a specialty co-management agreement including all corporate transactional agreements and development of applicable co-management measurement metrics in compliance with federal fraud and abuse requirements.

  • Represented a physician specialty group practice in asset sale to tax-exempt hospital system and related development of a center of excellence. Varied employment arrangements for all acquired providers. Purchase price was in excess of $5 million.

  • Drafted Amicus Curiae brief on behalf of the Georgia Hospital Association and the Georgia Health Care Association regarding denials from trial courts of qualified protective orders allowing ex parte interviews with plaintiffs’ treating medical providers.

  • Served as health regulatory counsel on private equity investor’s acquisition of a Southwest-based provider of outsourced third-party eligibility, revenue cycle management and billing services for 300 hospitals in 33 states. Focus included compliance with Social Security disability advocacy requirements, permissibility under state law of percentage fees for billing and impact of need to obtain new biller submitter IDs on timing of closing and structure of transaction.

  • Represented a publicly held, non-traded REIT in the acquisition and leaseback of a large surgical hospital. The transaction involved a recently completed facility and included an option for client to purchase future development.

  • Represented a large hospital system in fraud and abuse analysis related to the development and securities offering of multi-specialty ambulatory surgery center.

  • Represented a large hospital system in the negotiation and drafting of a specialty joint venture agreement, including all regulatory analysis and drafting of corporate transaction documents.

  • Obtained fully favorable judgments from U.S. Administrative Law Judge (ALJ) in a series of Medicare reimbursement appeals for mid-western long-term care hospital.

  • Represented Newnan Hospital by negotiating, developing and documenting a plan whereby the client, a nonprofit hospital, was sold to a large nonprofit hospital system, Piedmont, on terms which assured the community that Piedmont would build a new hospital for the community to replace the existing hospital which occupied two buildings built in the 1920s and 1950s. The new hospital, Piedmont Newnan Hospital, opened in May 2012.

  • Represented solo physician specialty practice in asset sale to publicly traded physician management company. Transaction included negotiation and transfer of exclusive services agreement with multiple area hospitals. Development of post-closing contingent compensation system tied to individual physician requirements and needs. Varied employment arrangements for all acquired providers. Purchase price was in excess of $4 million.

  • Represented a 30-physician specialty group practice in stock sale to publicly traded physician management company. Transaction included negotiation and transfer of exclusive services agreement with multiple area hospitals. Development of post-closing agreement on management and policy that included recognition of senior and junior physicians, intra-practice leadership and transition models. Varied employment arrangements for all acquired providers. Negotiation and early termination of office lease, including all physician guarantees. Purchase price was in excess of $70 million.

  • Represented a physician specialty group practice and related ambulatory surgery center in asset sale to tax-exempt hospital system and related development of a center of excellence. Transaction included development of post-closing agreement on management and policy.  Varied employment arrangements for all acquired providers. Purchase price was in excess of $4 million.

  • Successfully represented multiple health systems, after extensive appeals in obtaining the certificate of need permitting them to establish hospitals in Roswell, Ga. (now North Fulton Hospital) and Pleasant, SC.

  • Advised multi-state hospital system on various regulatory matters, including credit balances and state unclaimed-property requirements.

  • Advised national hospital system in structuring charity policies for state compliance.

  • Counseled a non-profit healthcare provider on the Georgia Hospital Authority Act, including related Certificate of Need, licensure, and Medicaid rules and regulations related to a corporate reorganization.

  • Represented a receiver in its acquisition of a hospital chain pursuant to a court-approved comprehensive settlement agreement.

  • Representing university and hospital system in defending lawsuit alleging tortious interference with business relations, defamation, and RICO violations.  After filing a motion to dismiss based on Georgia’s anti-SLAPP statute, plaintiff voluntarily dismissed the case. Other issues in the case are scheduled to be heard by the Georgia Court of Appeals.

Recognition

AGG offers one of the largest healthcare-dedicated practices in the country, as noted in an issue of Health Lawyer News.

 

The ABA Health Law Section has recognized AGG’s healthcare practice as one of the top practices in the Southeast and Washington, D.C.

 

Our practice and attorneys are consistently ranked in publications including Chambers USA and Best Lawyers.

News & Insights

Healthcare Authority Newsletter

The Healthcare practice at AGG produces a weekly newsletter which includes current news briefs relevant to the healthcare industry as well as articles and announcements, all for the benefit and interest of our clients and other industry members.