Cutting-Edge Legal Services for Healthcare Providers and Organizations
While our practice experience runs the full gamut of health law, our attorneys are pioneers in four practice areas in particular that have surged over the last decade: payer audits, benefit claim reimbursement disputes, multidisciplinary practice, and behavioral health.
Navigating Third-Party Payer Audits and Refund Demands
Simply put, no law firm in the country can match the scope and breadth of our experience in defending healthcare providers in both post-payment and pre-payment audits. While healthcare providers have seen a dramatic rise in refund requests and overpayment demands from both Medicare and commercial payers over the last decade, these disputes have been a core focus of our Firm from the first day we opened our doors. And today we routinely counsel providers (and their attorneys) throughout the country in overpayment disputes with both governmental agencies and private insurance carriers.
We have leveraged our familiarity with the tactics employed by various carriers in serving as co-lead counsel in several class actions challenging the legality and fairness of the often mysterious and one-sided audit processes employed by some companies.
Seeking Full and Fair Payment for Healthcare Providers and Facilities
Healthcare providers and institutions face challenges unlike other businesses in obtaining payment for their services. The complexity of healthcare reimbursement is a result of the prevalence of third-party payment, intricate payment arrangements, the inimitable regulatory structure, and other factors. This reduces practice revenue and eats up time that could be spent treating patients and working with clients.
We counsel our clients on how to handle third-party claims submissions from the moment the patient walks in the door for the first time to when the patient is discharged and a significant balance remains unpaid. We stress the importance of meticulous documentation, both clinical and administrative, and strict adherence to the administrative appeal processes available. If this diligence fails, we rely upon our extensive knowledge of both Medicare and private insurance carrier reimbursement, including the Employee Retirement Income Security Act of 1974 (ERISA), to vindicate our clients’ rights in negotiation and litigation.
Our efforts on behalf of clients have secured millions upon millions of dollars in previously denied reimbursements, including one of the largest class action settlements by a commercial health carrier with a class of licensed healthcare providers in history.
Reducing Costs and Improving Care Through Multidisciplinary Collaboration
The changing paradigm in healthcare is that treatment decisions are no longer made in isolation by individual treating providers. And provider groups or delivery systems that can effectively deliver coordinated care in line with marketplace realities and opportunities are generally positioned to thrive. A multidisciplinary group is one in which providers of different specialties share facilities, administration, income and expenses, support staff, and equipment. Indeed, as medicine becomes increasing specialized, multidisciplinary group providers can collaborate with providers well-versed in other areas of medicine to treat the whole patient: seamless referrals and opportunities for patients to develop a relationship with support and administrative staff that transfers across all their lines of treatment.
We have significant experience in advising clients not only on the legal, operational, and financial dynamics of multidisciplinary practice, but also in the practical realities of integrating multiple clinical specialties and ancillary services lines into a single, cohesive delivery unit.
Facilitating Access to Addiction Treatment and Behavioral Health Services
Our country—and New Jersey in particular—is in the throes of an opioid epidemic unprecedented in scope and devastating in intensity. New Jersey saw a 40 percent increase in drug-related deaths in 2016, the largest in at least six years and a spike driven by the opioids heroin and fentanyl, according to data from the New Jersey Office of the Attorney General. The rise in deaths is consistent with a national trend of deadly drug abuse. More than 64,000 people died nationally of drug-related causes in 2016, the most in recorded history.
Despite this, some of the most serious cases are not receiving appropriate treatment. “Dual diagnosis” refers to a substance abuse problem existing in tandem with a mental health disorder. More than half of all substance abuse cases involve dual diagnosis patients. Dual diagnosis addiction treatment is more extensive and complex than standard addiction treatment. It addresses the mental health symptoms that can reach extremes when substance abuse develops alongside them. And while there are many factors influencing the ongoing opioid crisis in the United States, and a lack of effective dual diagnosis care is a major one.
Over the course of the last five years, our firm played a prominent role in improving access to dual diagnosis care by representing behavioral health facilities including outpatient substance use disorder treatment facilities, outpatient mental health facilities, and residential substance use disorder treatment facilities in all matters of licensure, contracting, and accreditation. We routinely counsel both startup facility operators and established behavioral health systems on issues related to program development, facility operations, staffing, client rights/grievances, regulatory compliance, reimbursement and payer contracting, and the prevention of fraud and abuse.
Integrated Legal Services for Healthcare Providers and Organizations
In addition to the above areas of emphasis, we offer a broad range of services tailored for the unique needs of healthcare businesses, including:
- Business transactions counselling that focuses on our clients’ transactional and contractual needs from both legal and business points of view.
- Aggressive representation in litigation and dispute resolution in civil lawsuits — from employment law matters to insurance overpayment issues.
- Skilled, strategic healthcare criminal defense in allegations of insurance fraud, Medicare or Medicaid fraud, and other white-collar crimes.
- Pragmatic and cost-effective solutions for navigating the regulatory morass implicated by the organization, licensure, acquisition, and/or sale of licensed and/or accredited healthcare facilities.
- Creative and comprehensive strategies designed to achieve legislative, regulatory, and legal goals of professional associations, and their membership.
- Shepherding clients through the rapidly changing reality of Health IT.
- Advice and representation in all areas of professional license defense and administrative proceeding initiated by state or federal regulatory agencies.
- Risk management and compliance counseling strategies developed for your specific needs and situation.