Health Care: Moore & Van Allen

Overview

Our Health Care group has vast experience in, and a thorough understanding of, the health care industry. We use deep regulatory knowledge and a practical approach to problem-solving with the goal of becoming trusted advisors for our clients. Our clients benefit from the perspectives of our attorneys, including attorneys who practiced in-house at large provider organizations, related to the risks, challenges, and opportunities that exist in the rapidly changing health care industry. We understand that our health care provider clients are called upon to reduce cost, improve quality, and increase access to care while adhering to complex and evolving reimbursement rules and complying with dense regulatory requirements. Additionally, we recognize that our clients who invest in, or provide services to, health care organizations must make risk-intelligent strategic decisions in the face of potential public policy shifts and disruptive technology developments.

We represent a wide spectrum of health care providers, private equity and institutional investors and lenders, and technology and other companies in the health care industry. Our provider clients include hospitals and health care systems, medical groups, long-term care providers, behavioral health providers, medical professional staffing companies, and other inpatient and outpatient service providers who depend on our group’s innovative health care attorneys for responsive, knowledgeable legal counsel in transactions, regulatory compliance, and operational and enterprise risk management. We assist our clients in pursuing their strategic objectives, helping assess and mitigate risk related to emerging business models, professional dynamics, and technologies.

Transactions

We have extensive experience in health care mergers, asset and equity sales and acquisitions, joint ventures, strategic alliances, and financings. Our group’s combined transactional and regulatory experience enables us to assist our clients to structure, negotiate, and complete transactions effectively and efficiently. Our transactional work includes advice on the optimal structure for a transaction, negotiation of definitive transaction, and ancillary agreements in accordance with health care regulatory requirements, as well as counseling on operational integration. We have also advised clients with respect to structuring management services arrangements with medical, dental, and other professional practice entities in compliance with laws that prohibit or limit the corporate practice of those professions. We also regularly represent borrowers and lenders in health care lending transactions involving health care providers and companies providing services to the health care industry located throughout the United States.

Regulatory Compliance and Risk Management

We advise clients in all areas of governance, operations, risk management, and regulatory compliance, include the following:

Stark, Anti-Kickback Statute, False Claims Act and similar state laws;
enterprise risk management and operational risk management;
corporate compliance, including development and enhancement of compliance policies and programs and counseling regarding compliance matters;
reimbursement matters, including payor contracting, audits, recoupments and overpayments, state insurance laws and regulations; negotiation and development of CINs, ACOs, bundled payment and other value-based payor arrangements;
medical staff bylaws and governance matters, NPDB reporting matters, and serving as counsel in fair hearing proceedings; and
tax-exempt rules and regulations applicable to 501(c)(3) organizations.

Health Care Data Privacy & Security Compliance & Breach Response

We provide advice and counseling regarding HIPAA and other applicable state and federal laws. Examples include:

development of policies to comply with HIPAA’s privacy and security requirements and advice regarding ongoing day-to-day HIPAA compliance;
investigating possible breaches and coordinating notices to affected individuals, the media and the Office for Civil Rights;
negotiation of health care technology and cloud service agreements, including related business associate agreements; and
diligence related to data privacy and security issues in health care transactions.

Litigation & Investigations

Our Litigation group, which includes our White-Collar, Regulatory Defense and Investigations group, works collaboratively with our Health Care group, representing health care provider clients in criminal and civil investigations, as well as in other litigation involving government agencies, government and commercial third-party payors, and commercial disputes. Our group also provides litigation avoidance counseling and represents clients in a variety of administrative matters, involving licensing agencies, payor audits and disputes, Office for Civil Rights investigations and EMTALA investigations.

Certificate of Need Counsel & Litigation

Our Health Care group provides advice and counseling with regard to South Carolina Certificate of Need matters, including the following:

drafting of Certificate of Need applications, exemptions, non-applicability determinations, affected party notices and opposition;
coordination and collaboration with health care consultants and clients; and
assistance and representation before the state agency and its governing body and with petitioning and responding to appeals before the Administrative Law Courts and appellate courts.

Representative Work

Health Care Transactions

Represented a behavioral health and software provider in connection with its equity sale to a holding company owned by a privately held investment firm for $95,000,000
Assisted a national health system to form dozens of joint venture partnerships with physician investors in hospitals and outpatient service providers; provided ongoing operational support, including licensure and initial payor enrollment; negotiated hospital-based physician agreements and co-management agreements; developed clinical and operational policies and procedures for the hospitals, specialty providers and physician practitioners; handled investigations by government enforcement authorities; and sold client’s facilities to many of the leading national for-profit and non-profit health care systems
Represented a national group purchasing organization in connection with its acquisition of a software-as-a-service provider of technology solutions to hospitals
Represented the owner of radiation oncology centers in connection with a restructuring and sale to a new joint venture with a large Southeastern health system
Represented the purchaser in the acquisition of an ambulatory in-center and home infusion business for $85 million
Represented an orthopedic group practice in the $20 million sale of its ambulatory surgery center to a national provider of ambulatory surgical services
Represented the purchaser of a home dialysis business joint venture
Represented the owners of a surgery center in connection with its sale to a private equity backed investor
Represented providers in negotiation of strategic alliance with nonprofit hospital, including service line co-management agreement
Represented some of the largest non-profit healthcare systems in the Carolinas, as well as several leading academic medical centers, which has included handling a wide range of transactional representative matters for these clients involving whole hospital acquisitions, large physician practice acquisitions, and other M&A activity

Health Care Data Privacy & Security Compliance & Breach Response

Drafted, and assisted in implementation of, HIPAA privacy and security policies for a national health care provider, including preemption analysis and identification of state privacy laws to be addressed
Represented a long term care facility in connection with handling of a breach investigation and response, including necessary reporting to affected individuals and government agencies
Represented a growth equity firm focused exclusively on software and technology-enabled business services in connection with its acquisition of a supplier of software, hardware and other technology platforms for self-service patient registration solutions in the healthcare industry
Represented a health system in connection with a breach investigation by the Office for Civil Rights

Health Care Litigation & Investigations

Represented the owner of a health care marketing business in an investigation by the U.S. Attorney of an alleged anti-kickback scheme
Represented multiple providers in connection with qui tam litigation brought by whistleblowers
Represented a hospital provider to self-report potential False Claims Act billing violations to the Department of Justice
Represented a provider in the investigation of billing practices for services covered by third-party payors, including Medicare and Medicaid, by U.S. Attorney and state criminal and civil authorities