The U.S. health care industry is one of the largest, most complex, and most heavily regulated systems in the world. It is also one of the most unpredictable. Today, health care providers and institutions have to respond to health care reform, expanded coverage rules, value-based Medicare reimbursements, pressures to reduce costs, and hospital and health system mergers and acquisitions. Tomorrow, they will have to confront a whole new set of changes. In this fluid business environment, Cozen O’Connor’s health law team helps clients address issues with government and non-government payers, stay ahead of and compliant with existing and new regulations, and lead the industry in becoming conversant about the Medicaid, insurance coverage and fraud and abuse aspects of the Affordable Care Act.
Our firm offers a full array of services to major players in the health industry, including hospitals, health care systems, MCOs, providers and suppliers, device manufacturers, health care entrepreneurs, academic medical institutions, and physician groups. We represent clients in high-stakes health industry litigation including False Claims Act cases, one of the first Stark Law disclosures, and government investigations, including addressing the ACA’s 60 day repayment requirement. We have a national reputation as the go-to firm for payor disputes. Our regulatory experience is similarly broad, encompassing privacy and HIPAA/HITECH issues; Medicaid, Medicare, and third-party reimbursement; provider-payor relations; Medicare Secondary Payer Act guidance; provider-based issues; physician-vendor relationships and Physician Payment Sunshine Act; and general compliance, licensure, and certification requirements. Finally, we provide transactional guidance on mergers, acquisitions, restructurings, and joint ventures or co-management arrangements; tax, bankruptcy, and antitrust matters; and all manner of health industry contracts.
All our work in the health field is grounded on one attribute: a deep knowledge of the governing body of law, including the Medicare and Medicaid statutes and implementing regulations and commercial third party payor law. Health is such a heavily regulated industry that no matter what the client’s goal may be – consolidation of two healthcare systems, launch of an MRI facility, challenge to a Medicaid underpayment, or compliance with complex regulatory requirements – the difference between success and failure often turns on mastery of the complex, ever-changing statutory regime.
The team at Cozen O’Connor is unique in that our attorneys combine statutory knowledge with hands-on practicality. Our job, after all, is not to produce doctoral theses on the minutiae of every health code. Instead, it is to provide accurate and concise advice that helps clients achieve their goals. That means using our regulatory experience to secure maximum reimbursements, limit liabilities, and complete transactions efficiently and profitably.
To do that, our health lawyers must be creative. In this confined legal space, one filled with dead ends, narrow passageways, and low ceilings, our talent lies in finding new routes through the maze. Cozen O’Connor’s attorneys are nationally recognized for their ability to identify uncommon legal solutions to seemingly intractable problems. They have successfully reached negotiated solutions in highly contentious litigation matters, achieved favorable results in litigation, and designed innovative transactional models that have been adopted by lawyers in other firms.
Our health clients also benefit enormously from the professional relationships our attorneys have with officials in key regulatory bodies, including the Centers for Medicaid & Medicare Services, Department of Justice, state attorneys general offices, state departments of welfare, and state and federal legislatures. We have earned the respect of government administrators over decades of practice. This enables us to reach out to officials to resolve potential issues before they crystallize, and it gives us valuable insight into regulators’ priorities.
SERVICES
Litigation
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Handle a broad array of third-party payor litigation and arbitration
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Represent clients in Provider Reimbursement Review Board proceedings
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Respond to fraud and abuse, and Stark Law claims, including making strategic decisions about disclosures and other repayments
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Provide False Claims Act representation
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Conduct internal investigations and respond to government investigations
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Defend health care clients in enforcement actions brought by federal and state agencies
Regulatory
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Advise on privacy, security, and other HIPAA/HITECH-related compliance issues
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Counsel clients on Medicare, Medicaid, and other third-party reimbursement matters
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Counsel clients on state and federal Anti-kickback issues and Stark and Codey issues
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Develop and assess compliance programs
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Counsel clients on compliance with the Medicare Secondary Payer rules
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Counsel health care providers and institutions about licensure and certification requirements
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Develop programs to comply with the Physician Payment Sunshine Act
Transactional
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Represent a variety of clients in mergers, acquisitions, divestitures and restructurings
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Structure joint ventures and co-management arrangements
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Identify and resolve antitrust, tax, and bankruptcy issues for health care organizations
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Arrange financing for assisted living facilities, hospitals, and nursing homes
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Structure contracts between MCOs, third-party payors, and plan administrators
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Develop integrated delivery systems
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Structure relationships between hospitals and medical staff
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Form physician practice groups and physician practice management organizations
CLIENTS
Our clients include a full range of nonprofit and for-profit health care organizations:
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Health care systems
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Hospitals
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Nursing homes and senior living facilities
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Hospital, nursing home, and pharmacy trade associations
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Managed care organizations
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Physician groups and physician practice management companies
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Academic medical institutions
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Entrepreneurs
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Home health and home care companies
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Suppliers
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Device manufacturers
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Mental health providers
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Pharmacies
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Banks, financial institutions and others involved in the financing of health care enterprises
TEAM
Cozen O’Connor’s health law team has stellar legal, professional, and academic qualifications. The group chair was the former deputy chief counsel to the Centers for Medicare & Medicaid Services overseeing all federal litigation under the Medicare and Medicaid programs. The team includes attorneys with graduate degrees in public health, business, and accounting. Many author scholarly articles and speak about cutting edge health law issues to a wide variety of audiences.
A notable feature of Cozen O’Connor’s health care practice is its collegiality. This directly benefits clients because it means that colleagues are aware of each other’s skills and can leverage the group’s collective experience to respond to client matters. Health law is also well integrated into the larger firm, and the culture of collaboration extends beyond the practice group. The health team is backed by top practitioners in labor and employment, insurance, bankruptcy, real estate, and litigation. We understand that most problems are multidimensional, so our attorneys work together to devise comprehensive solutions.