Transactional and Compliance

The Transactional and Compliance Practice Group focuses on four areas:

Provider Organization and Operations
Compliance
Managed Care Contracting
Hospital-Physician Contracting

1. Provider Organization and Operations

• Formation of corporations, partnerships and limited liability companies for medical groups, IPAs, MSOs, surgery centers, imaging facilities, and other service providers
• Preparation of shareholder ("buy-sell") and partnership agreements
• Preparation of physician employment and independent contractor agreements
• Facility licensing and certification
• Preparation of Medicare (and Medicaid) Provider Enrollment applications
• Mergers of medical groups
• Integrated delivery system formation and re-structuring
• Preparation and negotiation of medical office leases
• Medical practice and IPA purchases and sales
• Practice buy-in arrangements
• Private placements and syndications for IPAs, surgery centers and imaging facilities
• Preparation and negotiation of computer hardware and software agreements
• Preparation and negotiation of management services and billing agreements
• Preparation of Fictitious Name Permit Applications
• Advice and negotiation of practice withdrawal and termination of employment
• Dissolution of corporations and partnerships

2. Compliance

• Analysis and structuring of transactions for compliance with federal fraud and abuse and "Stark" laws and state anti-kickback and self-referral laws
• Compliance audits and development of compliance plans
• Defense of overpayment determinations
• HIPAA
• Defense of Medicare and Medicaid suspension actions
• Advice regarding voluntary disclosure

3. Managed Care Contracting

• Preparation and negotiation of full medical risk, specialty capitation and preferred provider agreements
• Evaluation of capitation rates and covered services
• Preparation and negotiation of physician services agreements
• Formation of full medical risk and specialty IPAs
• Compliance with federal and state laws regulating HMOs and insurance companies
• Handling of provider payment disputes
• Physician credentialing
• Physician "de-selection"
• Advice concerning solicitation of managed care contracts and enrollees

4. Hospital-Physician Contracting

• Preparation and negotiation of hospital-based physician agreements for anesthesiologists, radiologists, emergency and other physicians
• Preparation and negotiation of medical director agreements
• Preparation and negotiation of on-call coverage agreements
• Review and negotiation of physician recruitment and relocation agreements
• Preparation of responses to Requests for Proposals for exclusive contracting
• Disputes over department closure and scope of exclusive contracts