Skilled Nursing Facilities

Clients seek our counsel and advice because of our deep understanding of their business and our encyclopedic knowledge of the industry.


We use our knowledge of the industry to provide practical and actionable representation that helps advance our clients’ goals and plans. We handle matters for our skilled nursing facility clients relating to regulatory compliance; licensure, survey and certification reviews, and enforcement actions; Medicare and Medicaid reimbursement; recovery audit contractor (RAC) audits and contractor reviews; federal and state administrative appeals; mergers and acquisitions; change of ownership (CHOW); fraud and abuse; internal and government investigations; involuntary discharge and resident payment issues; and certificate of need (CON). We’re particularly known as leaders in nursing home acquisitions and in administrative appeal work.

Over the years, we have worked with geographically diverse providers, ranging from single-entity nursing facilities to the largest regional and national nursing home chains, including ten of the top fifteen largest nursing home companies in the country, as determined by Provider magazine. Our healthcare attorneys have earned a national reputation as leaders in nursing home acquisitions and in administrative appeal work.

The excellence of our work on behalf of our clients has been recognized by Chambers USA and Best Lawyers in America. Our attorneys are also sought-after by news outlets for their expertise, and they’re frequently quoted in publications such as McKnights for stories about aging and skilled nursing.


  • Represented a publicly traded REIT in a $1.125 billion acquisition and restructuring of a senior housing provider that operates 96 senior-living communities as well as pharmacies in the Midwest.

  • Represented the seller of a nursing home facility and related assets located in Washington, DC in a $13 million transaction.

  • 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.

  • 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.

  • 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.

  • Successfully represented COBRA plan sponsor in dispute with third-party benefits administrator.

  • Represented a Georgia municipal hospital authority in its acquisition of a skilled nursing facility.

  • 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.

  • Conducted internal investigation for national nursing home chain regarding patient reauthorizations and reimbursement issues.

  • Participated in representing a healthcare private equity investor in the $2.4 billion dollar sale of the real estate assets of a national nursing home company.

  • Compelled arbitration for nursing home provider, then prevailed at arbitration and received an award of attorney’s fees and costs against the plaintiff.

  • Implemented a novel strategy of filing a federal lawsuit to successfully compel arbitration of a nursing home case, for Kindred Nursing Centers, resulting in a decision of first impression in Georgia. (Kindred Nursing Centers Limited Partnership v. Cynthia Jones, USDC Southern District of Georgia, Case No. CV409-105 (March 16, 2011))

  • Successfully obtained default judgment for nursing home client in case alleging breach of contract.

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

  • 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).

  • Represented a private investment management firm in an $870 million acquisition of the real estate and transfer of operations to 4 separate operating entities for over 160 senior care facilities across 12 states, including both skilled nursing and assisted living facilities.

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

  • Represented national employer sponsor of a large defined contribution plan in connection with multiple plan operational failures and preparation of an IRS compliance application to ameliorate the failures and restore the plan’s operational compliance.

  • Represented one of the nation’s largest private post-acute care providers in a merger with a publicly traded post-acute care provider resulting in a combined publicly traded company with annual revenues of $5.5 billion.

  • Representing Lenbrook Square Foundation Inc., a premiere nonprofit continuing care retirement center in Atlanta, since its conception in 1980 until the present. In 2006, Lenbrook issued $172,775,000 of tax exempt bonds, the proceeds of which were used to expand Lenbrook’s campus.

  • Resolved through a global civil settlement, with the U.S. Department of Health and Human Services, Office of Inspector General and the U.S. Department of Justice, a 3 year investigation involving quality of care issues at two skilled nursing facilities.

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