Our clients include a full spectrum of actors in the health care sector including health systems and hospitals, nursing home and long-term care facilities, academic medical centers, medical schools, health care professionals, clinics and ambulatory facilities, federal qualified health centers, independent practice associations, managed care organizations, hospices, home care agencies, early intervention agencies, regional health information and data system integration organizations, pharmacies, medical device and technology companies, and professional societies and trade associations.
HSE’s health care team includes lawyers who have served as in-house counsel at a regional health system, litigators who have shaped significant health care legislation, health care association board members, and seasoned investigators including a former Manhattan-based Assistant U.S. Attorney.
Contact our HSE health care team for our latest insights about the following:
Skilled Nursing Facilities and Medicare Reimbursement. Medicare reimbursement to skilled nursing facilities (SNFs) through a prospective payment system (PPS) has shifted such that the financial incentives for SNFs to provide therapy to residents have been greatly reduced. At the same time, government regulators at the Centers for Medicare and Medicaid Services have made clear that they will be monitoring the amount of therapy SNFs provide under the new system compared to what they provided under the old. SNFs that reduce the amount of therapy without regard to the needs of their residents could face significant liability. The HSE health care team regularly advises SNFs regarding audits and related compliance issues and is well-positioned to assist facilities navigating this change in reimbursement policy.
Health Information Exchange and Systems Integration. With an eye toward integrating the services available from health care providers, social services agencies, and schools and universities, organizations are already exploring how the data systems for these entities might be integrated. HSE’s health care lawyers were at the forefront of creating a regional health information organization (RHIO) and now work toward even more extensive integration of data systems and exchanges.
Health Care Transactions. We expect a continuation of the trends to increase provider scale and broaden continuums of services that were spurred by the shift to the “pay for performance” reimbursement models that became more widespread after the passage of the Affordable Care Act. Mergers and acquisitions will continue to play an important role in the expansion of larger health care providers in New York and across the country. We also anticipate that both payors and providers will continue to look to expand into each other’s industries in an effort to control both the quality and price of care. HSE’s Health Care team works regularly and closely with other firm practice groups to lead large and complex transactions to successful completion.
Where we started: Our client, a non-profit federally qualified health center look-alike, provides comprehensive and integrated care to underserved communities and vulnerable populations. A county clinic located outside of our client’s service area sought to partner with our client to offer our client’s specialized clinical services to underserved patients in the county. These patients did not have access to transportation to visit a clinic. To better serve these patients, our client obtained grant funds to establish a telemedicine service to meet the unserved need which involved, in part, providing telehealth equipment and infrastructure to the county clinic. Because our client was providing equipment at no cost to the county clinic, it had to obtain an advisory opinion from HHS’s Office of the Inspector General (OIG) permitting the implementation of the telemedicine program. Given the binding nature of such opinions and the fact that such opinions are relied upon by others in the industry as guidance, the OIG is often reluctant to issue them.
Our strategy: Working closely with our client and officials at the OIG, HSE’s health care team gathered the necessary facts to demonstrate the unique needs of the underserved population and how those needs could be met through the implementation of the telemedicine program and the provision of this equipment to the county clinic. We also addressed several other significant regulatory issues raised by federal authorities. After extensive documentation production and interaction with the officials at the OIG, our client was able to secure a favorable advisory opinion.
The outcome: The telemedicine program provides access to specialized treatment for at-risk individuals in New York State who are geographically limited in seeking treatment.
Where we Started: Our client, a health care provider, called us to report that one of the independent contractors working for them had records containing highly sensitive protected health information of almost 800 of our client’s patients stolen from the contractor’s car.
Our strategy: Within hours, members of our health care team were onsite at the client’s offices and had developed a comprehensive action plan that considered both the client’s legal compliance obligations and the practical aspects of the client’s business. Specifically, we advised our client on how to meet its obligations under state and federal law including the timing and notice requirements of the affected patients and the media, and the breach reporting requirements to the appropriate regulatory authorities. We also offered practical, strategic advice in response to specific responses to patient questions and concerns. In addition, anticipating questions from the U.S. Department of Health and Human Services (HHS), Office of Civil Rights, we proactively helped our client assess and update its privacy policies and procedures to prevent a future breach, and retrained our client’s workforce.
The outcome: Working quickly and decisively, we were able to help the client implement a plan of action that helped avoid what could have been significant regulatory fines while at the same time preserving relationships with patients. We also set our client up for success in the future by tightening up aspects of the client’s privacy program.