Health Care Industry Legal Services

Behavioral Health Care, Developmental Disabilities and Child Welfare

Our attorneys have extensive experience representing organizations and professionals involved in the field of behavioral health (mental health and alcohol and drug treatment and prevention), developmental disabilities (DD) and child welfare.  We represent a variety of statewide trade associations in the behavioral health and DD fields on numerous issues, including systemic regulatory and reimbursement matters, as well as the development and implementation of Medicaid waiver programs.  We work with trade association leadership on a day to day basis and understand the challenges faced by associations and their members not only with regard to specific regulatory issues but also as employers in a highly regulated industry.

We represent providers with Medicaid managed care contracting issues and understand the unique challenges that providers face as Medicaid managed care is rolled out to include specialty populations where the individuals served are particularly vulnerable.

We have represented many providers before state agencies, have negotiated contracts with various payors and have provided reimbursement counseling on complex Medicaid and Medicare reimbursement matters.  Our attorneys not only understand the more traditional institutional programs, but also are very experienced in the home and community-based Medicaid waiver programs, including 1915 and 1115 Medicaid waivers, as well as all types of community-based programming.

Hospitals and Health Systems and Ancillary Services

Our firm assists providers in health care operations, including advising institutions and their medical staffs and boards on governance issues.  Our attorneys represent hospitals and physicians in matters such as medical staff bylaws, rules and regulations, institutional review boards, TJC accreditation, advance directives, medical records, bioethics and other operational issues.

Whether the matter involves the day-to-day operations of a hospital or health system or issues associated with regulatory compliance, complex litigation, corporate compliance, board governance, medical staff issues, fraud and abuse or payor and reimbursement arrangements, our attorneys are fully equipped to address client needs.  We serve as outside counsel for many hospitals, health systems, nursing homes and other long-term care facilities, skilled nursing facilities and other health care institutional providers.  We also represent physicians, physician groups, home health agencies, ambulatory surgery centers, diagnostic centers and other outpatient service providers.  We also assist in creating and implementing professional liability self-insurance plans.

Academic Medical Centers

Vorys has extensive experience dealing with the unique issues faced by academic medical centers.  We represent medical schools, teaching hospitals, faculty practice plans, research institutes and affiliated organizations throughout Ohio and around the country.  We have assisted academic medical centers in all aspects of their operations.  Our attorneys have extensive knowledge and experience in fraud and abuse, federal Anti-Kickback Statute and Stark Physician Self-Referral Laws.  We counsel our academic medical center clients in connection with the formation, operation, and tax exemption of faculty practice plans, internal compliance audits, the consequences of the various payment arrangements that exist among teaching hospitals, medical schools, and faculty physicians and the increasingly complex interplay of Institutional Review Boards, the FDA and industry sponsored clinical trials and human subject research.  All of this, coupled with Vorys’ extensive history representing colleges and universities, provides Vorys the background and experience to offer our academic medical center clients comprehensive legal representation.

Joint Ventures/Hospital-Physician Collaborations

Our lawyers provide advice on health-related business transactions, such as structuring joint ventures between hospitals and physicians, forming and re-syndicating ambulatory surgery centers, physician employment and structuring and operating other ancillary service providers, including diagnostic imaging centers.  We are also experienced at unwinding joint ventures in the event that subsequent regulatory changes raise legal issues or frustrate the strategic purpose of the joint venture.  We understand the complexities of hospital-based and freestanding arrangements, and we counsel clients on ownership/investment issues, structural and operational considerations, supervision requirements and reimbursement concerns to ensure compliance with the array of regulatory issues that affect health care transactions.  Most importantly, we listen to our clients and draw on our experience and creativity to provide solutions that achieve their business objectives.

Managed Care

Our attorneys are experienced in dealing with the issues that arise in the relationship between health care providers and managed care organizations.  We have assisted health care providers with the design and implementation of integrated delivery systems, including physician-hospital organizations and management services organizations.  We have created and represented health maintenance organizations (HMOs) and health insuring corporations (HICs).  We also have assisted health care clients with contract negotiations with managed care organizations.

Practitioners

Our attorneys have assisted and advised a variety of healthcare practitioners, including physicians, nurses, advance practice nurses, physician’s assistants, social workers, counselors, substance use disorder providers and others, regarding scope of practice, ethical and billing issues.  We have represented and defended licensed practitioners in actions and investigations brought by state licensing boards.  We have extensive knowledge of the wide range of state and federal laws and regulations which affect Practitioners, and their ability to care for their patients and bill for their services.  Our attorneys provide a wide range of services, including contract review, regulatory analysis and business advice to aid these practitioners in delivering services.

Long Term Care and Senior Care

Long Term Care Facilities

Our attorneys understand the complexities of the long-term care business.  We represent nursing homes, residential care/assisted living facilities, independent living facilities, continuing care retirement communities (CCRCs), intermediate care facilities for individuals with intellectual disabilities and group homes.  We frequently counsel clients on regulatory issues, including licensure and certification, certificate of need, compliance, survey and enforcement, changes of ownership, Medicare, Medicaid, and business and clinical operations.

Our attorneys are well versed on the latest regulatory initiatives that may impact long-term care providers and have represented providers in matters pending before numerous federal and state regulatory bodies and provide expert assistance with governmental and internal investigations and audits.  We are also experienced in transactional matters, and assist clients with dispositions, mergers, acquisitions and complex joint ventures, including assistance with Medicare, Medicaid, diligence, state and federal filings, and preparation and negotiation of contracts.

Home Health

Our attorneys frequently counsel existing and startup home health agencies regarding compliance, surveys, licensing and certification, accreditation, changes of ownership and locations, business and operational issues, contracts, defense of fraud and abuse allegations and Medicare Conditions of Participation issues.  We also assist home health agencies with policies and procedures, reimbursement issues, and audits and overpayment issues.  Our attorneys have vast experience with transactional matters, including acquisitions and complex joint ventures, and assist with diligence, Medicare, state and federal filings and contracts.

Hospice and Palliative Care Providers

Our attorneys have broad experience in the full range of legal and regulatory issues impacting hospice and palliative care providers.  Our attorneys counsel hospice and palliative care providers on regulatory matters, surveys, audits, complex reimbursement, contracts, including agreements with other providers, DME, and vendors, corporate structuring, program development and transactions, including mergers, acquisitions and complex joint ventures.  Our attorneys are also experienced in fraud and abuse issues (Anti-kickback Stark and False Claims Act) and Medicare Conditions of Participation as they relate to specific hospice program issues.