Academic Medical Centers
Jay M. Howard
Mark H. Goran
Compliance (Fraud and Abuse, Stark)
HIPAA/Health Information Privacy and Security
Hospitals and Health Systems
Payor Disputes and Reimbursement Audits
Polsinelli attorneys value the opportunity to work with all types of academic medical centers, including those with a single integrated campus and those with separate legal components (i.e., school of medicine, clinical faculty practice plan, and a teaching hospital). Our academic medical center clients often face the most difficult and complicated patient care issues in our health system. Polsinelli attorneys know that the components of an academic medical center must collaborate to carry out their special missions of education, research, and clinical service. Like our academic medical center clients, our attorneys collaborate to provide effective strategies and solutions to address the complex legal issues that academic medical centers face. Our academic medical center clients include large and small institutions located in both urban and rural areas. We are well equipped to collaborate and resolve any legal issue that may arise in the academic medical center environment. We also have a cross disciplinary team that can assist academic medical centers in leveraging their intellectual property through technology transfers.
Our team includes professionals with diverse legal experiences working with each component of an academic medical center. We are privileged to provide day-to-day academic medical center representation to resolve the following unique legal issues:
Affiliations, Alignments and Other Joint Venture and Strategic Transactions
Accreditation, Faculty, and Residency Issues
Antitrust Counseling, Including Development of Clinically Integrated Networks
Faculty Practice Plan Compensation Modeling
Fraud and Abuse Compliance (Anti-Kickback, Stark, CMP and OIG/CMS Self Disclosure Issues).
Funds Flow and Financial Support Flowing Between Academic Medical Center Components, Including Securing OIG Advisory Opinions
GPO/Supply Chain Contracting
Labor & Employment
Lobbying and Congressional Affairs
Reimbursement Including Emerging Payment Models
Risk Management and Professional Liability Defense
Faculty Practice Plan Experience:
Represented a large faculty practice plan in faculty compensation/production benchmarking, compensation plan design and implementation for both employed and contracted faculty, including providing fraud and abuse compliance advice.
Represented a large urban academic medical center to partner with its faculty practice plan and form affiliation with rural hospital, including expansion of teaching program and support component.
Represented a large teaching hospital relative to large scale clinical integration and alignment objective with clinical faculty practice plan, including providing new tax exempt entity formation and fraud and abuse compliance advice.
Assisted academic departments and faculty practice plans in connection with the design of faculty compensation and incentive systems, including those for use in traditional (fee for service) and emerging value-based payment environments.
Assessed and provided compliance oversight relative to clinical faculty compensation structures in faculty practice settings for multiple departments, with attention to the interplay of incentive structures with health care regulatory/fraud and abuse compliance strategies.
Advised clients on professional service, clinical integration and similar relationships involving faculty practice plans, hospital-employed and community physicians, along and their relationships with teaching and community hospitals to participate in value based payment systems.
Negotiated and completed numerous professional service agreements and medical director agreements with the faculty practice plan and its members.
Negotiating and Managing Affiliations Between Teaching Hospitals and Schools of Medicine:
Negotiating complex funds flow arrangements between various components of an academic medical center (i.e., between teaching hospital, school of medicine, and faculty practice) and ensuring compliance with healthcare and tax laws and regulations.
Negotiating and supporting complex GME structures including hospital funding of residents and other GME overhead costs, determination of which residency programs receive priority funding and staffing, and protection against programs at risk of elimination or loss of accreditation.
Negotiating research support from hospital to university, including negotiation of joint intellectual property ownership, licensing and commercialization agreements.
Implementing bi-lateral agreements among teaching hospitals and schools of medicine to obtain and maintain NCI Comprehensive Cancer Center status.
Implementing exclusivity, non-competition, and non-solicitation arrangements among teach hospitals, schools of medicine and faculty practice plans.
Implementing effective physician recruitment plans that balance the sometimes competing clinical needs of the hospital with the teaching and research needs of the school of medicine.
Structuring complex and compliant physician compensation models unique to academic medical center settings.
Creating integrated governance and management structures among components of academic medical center.
Creating coordinated service line co-management arrangements between hospital executives and physician leaders, and academic department chairs and corresponding clinical service chiefs, and responding to competing concerns of each.
Coordinating risk and claims management among various pools of potential liability (e.g., hospital nurses, faculty practice plan physicians, and school of medicine students and residents).
General Academic Medical Center Experience:
Secured a successful OIG Advisory Opinion on the flow of funds in the AMC between the hospital and the school of medicine, which has become the foundation for many funds flows arrangements.
Negotiated the termination of a 35 year agreement with a public, for profit company that returned the outpatient cancer service line to the hospital.
Developed a primary care network with the acquisition and then creation of a 50 physician family practice network and the employment of the physicians.
Negotiated multiple affiliation agreements with the school of medicine and the research organization.
Completed the acquisition of a 25 physician cardiology group and the employment of the physicians.
Acquired a 35 physician oncology and radiology group from US Oncology.
Negotiated with HRSA on several 340B qualification issues.
Negotiated with CMS over numerous intergovernmental transfer issues.
Handled numerous matters for the closed Medical Staff, including matters involving reporting to the National Databank and disciplinary hearings tied to tenured faculty.
Concluded outlier disputes with the Justice Department.
Negotiated an AMC-based $100+M technology contract with one of the largest healthcare software companies in the world.
Represented a statewide health system in negotiating an academic affiliation agreement with a university medical center and affiliated medical school.
Represented a teaching hospital to negotiate academic affiliation agreement with medical school.
Represented a medical school in affiliation and alignment transaction with federally qualified health center.
Assisted a city based university to address services provided by an FFP physician group to teaching hospital (which is a separate entity that is unaffiliated with the university) and related compensation as set forth in interconnected agreements, including but not limited to an implementing education agreement, professional service agreements, income guaranty arrangements and the FFP compensation plan. Of interest is that the FFP is not a “group practice” under the Stark Law and the university has chosen to carefully construct incentive compensation to avoid inclusion of ancillary revenue.
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August 24, 2017
The Strategic Implications of MACRA
Understanding MACRAs Strategic and Compliance Implications
May 25, 2017
Webinar: Artificial Intelligence & Machine Learning
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Webinar: MACRA Proposed Rule – Key Proposals, Implications and Comment Opportunities
July 19, 2017
Webinar: Understanding MACRA’s Strategic and Compliance Implications
May 25, 2017
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