Health Care

The Health Care group has the vast national resources and strong Washington, D.C. connections that allow Polsinelli Shughart PC to deliver unique insight and results. With highly trained, regulatory-experienced attorneys practicing health care law in offices across the country, we are familiar with the full range of hospital-physician lifecycle and business issues confronting hospitals today. A mix of talented, bright, young attorneys and seasoned attorneys, well known in the health care industry, make up our robust health care team.

Polsinelli Shughart is the 10th largest health care law firm in the nation, according to the 2010 rankings from Modern Healthcare magazine.  The publication annually ranks law firms based on their total membership in the American Health Lawyers Association.  With one of the fastest-growing health care practices in the nation, Polsinelli Shughart has the depth and experience to provide a broad spectrum of health care law services, including:

  • Mergers and acquisitions, capital financing, real estate and asset purchases, certificates of need, construction, licensing and accreditation and certification for all types of health care providers, including: facilities, systems and entities
  • Operational issues relating to patient care, billing, emergency room services, consents, insurance, information systems and contracts
  • Management of PRRB and other administrative hearings, including professional board hearings and other state hearings and proceedings
  • Physician relationships with their affiliated institutions, including employment agreements, medical director agreements, professional service agreements, space and equipment leases and creation of joint ventures
  • Strategic assistance with medical staff structures, including creation of bylaws policies and procedures
  • Recruitment strategies for physicians and other health care providers
  • Corporate governance for health care organizations (for profit and nonprofit), including advice to boards of directors in the exercise of their fiduciary duties, management of conflicts of interest, and activities related to recruitment and compensation
  • Hospital regulatory compliance, including anti-kickback, Stark, HIPAA, EMTALA, false claims, antitrust, tax, Medicare Conditions of Participation, state licensure requirements, and Joint Commission standards
  • Development of thoughtful and practical compliance plans that are capable of implementation and monitoring
  • Representation in all levels of litigation related to legal and regulatory compliance
  • Labor and employment law, including discrimination, Family Medical Leave Act, wage and hour disputes, workers compensation, union organizational attempts, collective bargaining activities, and employee discipline and dismissal

Our clients include large multi-facility systems, academic medical centers, community hospitals, long-term care facilities and integrated health systems of all sizes as well as home health systems and hospice providers. We also represent more than 200 physician practice groups.

Our health care business and litigation groups are made up primarily of lawyers who either have extensive experience in the business or delivery of health care, or have completed advanced studies in health care law.

We provide a deep and broad knowledge base including HIPAA, EMTALA, regulatory appeals, licensure, regulations of human subjects research, managed care, Medicare and Medicaid regulations and enforcement of fraud and abuse.

Our health care attorneys know the industry trends and emerging issues by remaining active, or holding past chairmanship positions, in organizations such as American Health Lawyers Association, American Society of Medical Association Counsel, Kansas Association of Hospital Attorneys – Board of Governors, Missouri Society of Health Care Attorneys, Missouri Society of Hospital Attorneys, Greater Kansas City Society of Healthcare Attorneys and many others."

Notable Experience

  • Created and implemented a clinical integration program in compliance with FTC/ DOJ guidance involving a PHO in which the corporate member was a large urban academic medical center
  • Provided counsel to a multi-hospital system regarding the range of permissible joint activity pursuant to the Copperweld doctrine and other anti-trust guidance
  • Developed extensive anti-trust policy and guidelines for a major health information association in which competing vendors participate
  • Handled numerous physician practice acquisitions, including the development of a medical foundation model integrated delivery system that allowed for the integration of several groups of physicians into a new tax-exempt entity to provide medical services in a hospital system
  • Implemented a strategy that allowed a hospital to acquire several practices of specialists (neurology, cardiology, neurosurgery and orthopedics)
  • Developed a model for the purchase of physician practices by Hospitals that can be efficiently and economically implemented
  • Advising clients on a myriad of issues arising under HIPAA, such as whether a hospital physician can notify a patient’s significant other that the patient has tested HIV positive, when the patient is refusing to do so or whether a hospital can contact a police department when a patient is discharged so that a police officer can arrest the patient, to name just a few
  • Advising clients on the appropriate response, including preparation of motions to quash when subpoenas when necessary, for requests to release medical records when they fail to comply with HIPAA requirements
  • Development of a HIPAA compliance program, including policies, procedures, and self-study educational modules, for multiple clients, including a multi-provider hospital system


Newsletters & E-Alerts

July 23, 2010
On June 18, 2010, the Illinois Department of Public Health issued a Notice of Proposed Amendments to the Hospital Licensing Requirements, which implements two statutes enacted by the Illinois General Assembly in 2009.
July 20, 2010
The Centers for Medicare and Medicaid Services (CMS) have released the Final Rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program (the Meaningful Use Final Rule).  Simultaneously, the Office of the National Coordinator for Health Information Technology (ONC) released its Final Rule addressing certification criteria for EHRs (the Certification Criteria Final Rule).  These two Final Rules establish what criteria and technical standards constitute the meaningful use of EHR technology and establish eligibility for incentive payments.
July 8, 2010
On June 25, 2010, President Obama signed The Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 into law.  The Act provides a six-month delay of earlier legislation which, effective June 1, 2010, imposed a 21 percent reduction in reimbursement under the Medicare Physician Fee Schedule (MPFS).  The Act also increases MPFS reimbursement by 2.2 percent through November 30, 2010.
June 8, 2010
The popular Polsinelli Shughart Health Care Breakfast Series returns with an opportunity to ask questions of lawyers in the firm's Health Care Law practice.  During the complimentary breakfast event, attendees will gain perspective on how providers are navigating complicated reimbursement issues and creating business opportunities.
June 8, 2010
On April 13, 2010, the Joint Committee on Administrative Rules adopted amended Health Facilities and Services Review Board Administrative Rules (Amended Rules). The Amended Rules are effective for all certificate of need applications filed on or after April 13, 2010. The two most notable changes to the Amended Rules are the addition of charity care as a new criterion on the certificate of need application and waiver criteria for the financial viability requirements.
June 2010
The Illinois Department of Public Health (IDPH) recently expanded the Hospital Report Card and Consumer Guide to Health Care Web site by updating and adding new categories of data. The Hospital Report Card and Consumer Guide to Health Care Web site was originally launched in November 2009 as part of the implementation of the Hospital Report Card Act (210 ILCS 86). Under this legislation, all Illinois hospitals are required to report quality data regarding nursing care and infection control on a quarterly basis to the IDPH.
June 1, 2010
Steven K. Stranne and Alan K. Parver, Shareholders with Polsinelli Shughart PC, will provide a framework for understanding the new law and the ongoing trends in reimbursement, coverage, coding and funding for medical devices during a complimentary webinar event June 9. 
May 25, 2010
On March 18, 2010, the Joint Commission issued the revised Medical Staff standard MS.01.01.01, which was originally known as MS.1.20.  This standard addresses the governance structure of the Medical Staff and its accountability to the hospital's Governing body.
04/29/2010
Bruce R. Hopkins and Douglas K. Anning of Polsinelli Shughart's Nonprofit Organizations group presented a special webinar April 29 on the landmark Patient Protection and Affordable Care Act and its implications for nonprofit organizations.  Click on the headline above and follow the instructions to view the webinar in its entirety.
04/16/10
The landmark Patient Protection and Affordable Care Act signed by President Obama has relevance for nonprofit organizations, principally hospitals.  The new developments in the tax-exempt arena may leave organizations struggling to understand and comply.  Bruce R. Hopkins and Douglas K. Anning of Polsinelli Shughart's Nonprofit Organizations group have analyzed the new legislation and will share important implications for your nonprofit organization in a special complementary one-hour webinar event April 29.
February 25, 2010
As part of the Health Information Technology for Economic and Clinical Health Act, the Office of the National Coordinator for Health Information Technology (ONCHIT) released on December 30, 2009, an Interim Final Rule (IFR) that was published in the Federal Register on January 13.  That IFR detailed the initial set of standards, implementation specifications and certifications criteria that must be achieved in order to demonstrate the first stage of the "meaningful use" of electronic health record (EHR) technology and, by doing so, establish eligibility for various incentive programs.
February 10, 2010
Advisory board members of BNA's Health Law Reporter, including Polsinelli Shughart Shareholder Fred Entin, have released their annual outlook report, identifying the top 10 health law issues organizations should be aware of during the coming year, and commenting on what changes, if any, are likely to occur. While the recent Senate election in Massachusetts has created uncertainty about whether reform measures might be passed by Congress this year, health care reform continues to be a very important issue.
January 28, 2010
The Health Information Technology for Economic and Clinical Health Act (HITECH), which was included as part of the American Recovery and Reinvestment Act of 2009, created three incentive programs targeted at eligible health care professionals and hospitals that can demonstrate “meaningful use” of electronic health records (EHR). These programs provide payment incentives in the Medicare Fee-for-Service (FFS), Medicare Advantage (MA) and Medicaid programs. In order for hospitals and health care professionals to take full advantage of the EHR incentive programs, it is important to learn and understand the eligibility criteria and how to meet them.
December 1, 2009
On October 30, 2009, the Federal Trade Commission (“FTC”) delayed the enforcement date of the “Red Flag Rules” for the third time - until June 1, 2010. The Red Flag Rules require the implementation of a written compliance program to provide for the identification and detection of, and response to patterns, practices, or specific activities (red flags), that could indicate identity theft.
November 24, 2009
On October 30, 2009, the Centers for Medicare and Medicaid Services released the final rules for 2010 addressing the Outpatient Prospective Payment System (OPPS Final Rule) and the Physician Fee Schedule (PFS Final Rule). Combined, the two final rules and commentary comprise over 3,500 pages and address a variety of issues related to the payment system for hospital outpatient departments and physician practices.
November 6, 2009
On October 30, 2009, the U.S. Department of Health and Human Services (HHS), through the Office for Civil Rights (OCR), issued an interim final rule (Rule) to conform current regulations addressing Civil Money Penalties (CMPs) for violations of the HIPAA regulations to the statutory amendments made pursuant to the Health Information Technology for Economic and Clinical Health Act (HITECH), which was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA).

HHS invited public comments to the interim final rules until December 29, 2009. The interim final rule becomes effective on November 30, 2009, and HHS will consider all public comments to the interim final rule that it receives through December 29, 2009.
October 23, 2009
On October 1, 2009, the Office of Inspector General (OIG) published its Work Plan for 2010. The Work Plan identifies new, continued and revived programs and activities that will be the focus of the OIG in 2010. Health care providers should use the Work Plan as a reference guide to identify potential corporate compliance risk areas, update current policies and programs and determine the scope and focus of its annual audit plan.
September 29, 2009
On September 24, 2009, Governor Jay Nixon issued an executive order to examine the issues relating to timely reimbursement of Missouri hospitals and healthcare providers by health insurance companies. This update from Polsinelli Shughart's Health Care group provides information on the project and its effects on hospitals and providers.
September 8, 2009
New regulations, which apply to vendors who offer individuals a place to electronically store their personal health record, as well as, health care providers, health plans and clearinghouses who transmit health information electronically, expand the reach of HIPAA and federal privacy rules. With an increase in civil money penalties as well, it is important that organizations have accurate information about what is required and what the remedies are for not meeting the requirements.
August 21, 2009
A new CMS manual change which will significantly affect "consignment closet" or "stock and bill" arrangements between physicians and non-physician practitioners and DMEPOS suppliers. These changes are usually made by regulation and provide the practitioners with notice of the impending change. However, this change could require significant restructuring of existing arrangements and has been adopted by Manual change with an effective date of September 8, 2009.
August 10, 2009
Consolidating medical groups into large-scale physician practices is the wave of the future and will ultimately increase patient access to healthcare. Randal L. Schultz, vice chair of the Polsinelli Shughart Health Care group, will address the topic at a September 13 presentation to the Medical Development Specialists (MDS) Annual Conference in Las Vegas, Nevada.
June 18, 2009
The substantive and procedural changes to the civil False Claims Act (FCA) sweep broadly and will affect many health care providers, as well as other industry groups. Health care providers need to review their compliance programs and ensure such programs reflect the recent changes in the FCA.
May 19, 2009
Effective May 18, 2009, any Ambulatory Surgical Center (ASC) that has an agreement with Centers for Medicare and Medicaid Services (CMS) to participate in Medicare as an ASC must meet new notice provisions for patients of the ASC. The notice provisions set forth in the conditions for coverage require the ASC to provide to all patients (whether Medicare or private pay patients) or their representatives, in advance of the date of the procedure certain information.
May 7, 2009
On April 22, 2009, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) released a report finding nursing home corporations under quality of care corporate integrity agreements (CIAs) enhanced their quality of care structures and processes by integrating quality into their compliance programs. This report supports the fact that quality can be improved by integrating it with compliance.
April 20, 2009
Signed into law by President Obama on February 17, 2009, the American Recovery and Reinvestment Act (The Act) is intended to spur a significant change in the nation’s economic downturn. While The Act includes federal tax cuts and domestic spending in areas such as health care, it also includes non-economic recovery items such as a study on the effectiveness of medical treatments, which was a part of longer-term plans.
February 13, 2009
With a struggling economy and a new president promising action, the stage is set for changes in the nation’s health care system. Advisory board members of BNA’s Health Law Reporter, including Polsinelli Shughart attorney Fred Entin, have released their annual outlook report, identifying the top 10 health law issues organizations should be aware of during the coming year, and commented on what changes, if any, are likely to occur.

Awards & Recognition

October 27, 2009
Another award? We’ll take it. Polsinelli Shughart PC is excited to announce that 69 of our attorneys are included in the Super Lawyers® 2009 list for Missouri and Kansas. Attorneys from all the major offices of Polsinelli Shughart in Missouri and Kansas are represented among the honorees. Only five percent of attorneys in Missouri and Kansas receive this honor. In addition, Chairman Emeritus R. Lawrence Ward is featured in a Q & A editorial article “Brilliant Careers,” interviewed about his most interesting cases and advice for young lawyers.