Matters

  • Advised a variety of entities on the creation and operation of Medicare Shared Savings Program and commercial Accountable Care Organizations (ACOs) and Clinically Integrated Networks (CINs), including integrated health system ACOs, physician-led ACOs, and private ACO/CINs.
  • Assisted an operator of ACOs to establish its core set of agreements and operational processes, and helped to scale these processes up into a national model.
  • Helped providers rapidly understand and apply waivers of the Stark Law and other requirements to adjust their operations during the covid-19 pandemic, including by creating several “hospital at home” models.
  • Helped ACOs and other value-based models understand obligations under the Quality Payment Program and other areas of overlap between CMS payment models, and identify risks and opportunities of such overlap.
  • Helped a client obtain one of only two CMS Stark Law Advisory Opinions issued in 2020, concerning the ability of a nonprofit entity with physician members to develop a new hospital entity.
  • Developing a complex affiliation structure to develop strategic initiatives between Catholic and non-Catholic health care entities in compliance with applicable Ethical and Religious Directives.
  • Helped a large integrated health system administer its ongoing clinical integration strategy by identifying compliance needs, drafting agreements reflecting integration processes, and training relevant staff on compliance processes.
  • Provided ongoing advice to help health systems, physician practices, and other health care providers operate their businesses and enter into financial arrangements in compliance with the Stark Law, Anti-Kickback Statute, and other fraud and abuse laws.
  • Developed and reviewed physician practice management structures in various states to assure compliance with applicable corporate practice of medicine and fraud and abuse laws.
  • Prepared and filed multiple self-disclosures under the CMS SRDP and other refund processes, to reduce providers' federal program liability and comply with the 60-day overpayment refund obligation.
  • Assisted national physician organizations to understand and evaluate the impact of relevant federal statutes and rules, and drafted detailed comment letters, testimony, and supporting materials for Congress and CMS on behalf of these organizations. 
  • Advised physician practices on legal considerations of proposed or existing physician compensation methodologies, profit distributions, and integration of ancillary service lines. 
  • Assisted lenders and private equity firms to perform diligence on proposed transactions involving healthcare entities to assess the risks of such transactions and recommend modifications to applicable transaction documents.