Health care lawyers for healthcare professionals, facilities and businesses
Finding a healthcare lawyer that can navigate you through the labyrinth of rules, regulations and procedures that pervade modern health care is more essential than ever. For more than 25 years, our practice has focused on serving clients in diverse areas ranging from healthcare compliance, waste, fraud and abuse defense, general litigation, telemedicine, long-term care, hospital reimbursement, and various types of hospital and long-terms care facility purchases, sales and other transactions specific to the California healthcare industry. Whether you seek a HIPAA attorney, health insurance lawyer, mental health lawyer, DEA/FDA attorney; or are interested in physician contract negotiation or drafting a physician employment agreement, we are in your corner.
Our Philosophy & Approach
Nelson Hardiman’s philosophy is simple – we are absolutely committed to our clients’ success and satisfaction. And we do this by combining our attorneys’ “deep bench” of specialized knowledge with a proactive approach based on our firm’s collective experience in the California health care industry to provide you the most effective choice for your representation in connection with the full range of healthcare legal and compliance matters. Above all, we are proud of our preeminent record of protecting and advising the gamut of health care providers, from individual physicians to the largest healthcare systems. This legacy of providing turnkey service for healthcare providers is what makes Nelson Hardiman uniquely able to sort the “alphabet soup” that is our health care system today. Indeed, while it has always been a highly regulated industry, the advent of the Affordable Care Act
has introduced an unprecedented level of uncertainty to the operations of many providers. As a result, now more than ever you need seasoned and professional health care lawyers that can assist with ongoing operations and provide practical advice going forward. Nelson Hardiman loves working with entrepreneurs and early stage companies as well as mature organizations developing new products and service lines to advise on all aspects of compliance with licensing, operational, and reimbursement and ensure companies are structured to avoid problems. Frequently, we are not consulted until regulatory problems are suspected or discovered, in which case we manage investigations, resolve crises, and guide clients to “soft landings” and resolution of regulatory challenges. As health lawyers, we fully recognize the complexities posed by the myriad of state and federal laws that can govern virtually all aspects of a healthcare provider’s business. Our attorneys are at the forefront of these laws. Not only do we make sense of them; we ensure that our clients are protected if and when conflicts arise. Below are just some of the services and practice areas that we offer.
Medicare & Medicaid Fraud
Fraud, Waste and Abuse
remains a hot topic for many providers, in part due to the aggressiveness of recoupment efforts undertaken by OIG and other federal and state Medicaid enforcement personnel. In fact, California is a veritable lightning rod for investigations of Medicaid and Medicare fraud, and leads the country
in the amount of money recovered according to a 2012 report by the OIG. Nelson Hardiman has an unparalleled reputation in this area. One of the firm’s founding partners, Mark Hardiman
, has over a decade of experience with respect to civil and criminal investigations and charges concerning healthcare fraud and the False Claims Act (FCA), in addition to special insight gained from his more than eight years as former federal prosecutor in the Major Frauds and Major Crimes unit. Thus, whether you are a hospital, skilled nursing facility, medical transport/ambulance provider
, or any other player in the healthcare industry that participates in these programs, we can help. Of course, fraud and abuse charges are not limited to the Medicare and Medicaid programs. For example, Nelson Hardiman recently defended a San Diego chiropractor for alleged violations of California’s anti-markup statutes
concerning laboratory billing.
Mental Health Law
Reimbursement for mental health and behavioral services is another pressing issue for many of Nelson Hardiman’s clients. These services have traditionally been overlooked and/or underpaid by many insurance plans and, even with the advent of the federal Mental Health Parity and Addiction Equity Act, providers remain rightly concerned that health plans continue to deny or attenuate coverage through various tactics and strategies. We advise behavior health facilities and addiction treatment facilities and outpatient programs on all aspects of compliance. Nelson Hardiman’s attorneys remain vigilant for mental health discriminatory practices
and continue to track current events affecting mental health to ensure that coverage is available and paid for, just like any other type of necessary care.
HIPAA and Data Security
Nelson Hardiman regularly consults with clients on health privacy and data security compliance, including the Health Insurance Portability and Accountability Act (“HIPAA”). We are often retained as a HIPAA violation attorney when security, data, or confidentiality breaches
occur. We also provide HIPAA compliance
and audits, which strive to ensure that covered entities identify possible privacy risks and institute effective processes and procedures in place to avoid violations. We also advise clients on the state’s equivalent to HIPAA, the Confidentiality of Medical Information Act
(“CMIA”). Together, the HIPAA and CMIA broadly regulate not only patient privacy issues, but also data security and how medical information must be transmitted.
Health Insurance Law
Health insurers are highly-sophisticated players in the healthcare market, making them very effective at denying hospital and provider claims for a variety of reasons that may appear compelling. And while such denials may be appropriate in many instances, Nelson Hardiman has witnesses providers all too often write off accounts as “time-barred” or “uncollectable” when valid grounds existed for payment. We have successfully represented providers in many types of health insurance and managed care plan payment disputes, arbitrations and litigations involving thousands of claims and multi-million dollar underpayments fraught with complex issues including conflicting contractual interpretations, state and federal billing regulations, federal preemption and quasi-contractual obligations. We have achieved successes for our clients in this arena precisely because we have “been there” before. You too should have a sophisticated team in your corner committed to ensuring that you get paid for services rendered.
FDA / Medical Device Law
The Food and Drug Administration (“FDA”) remains very active in initiating investigations and filing enforcement actions against a variety of healthcare providers that fall within their broad regulatory ambit. As respected FDA compliance lawyers
, we have been involved in numerous matters, including those related to the use and importation of medications, pharmaceutical licensing compliance; off-label uses of drugs and devices; the manufacturing sale and marketing of cosmeceutical products; internet prescribing; and compliance with various regulations concerning issues such as Institutional Review Board (“IRB”) human research subjects; End Stage Renal Disease (“ESRD”) and mammography. We have also represented medical device companies in compliance with federal and state laws governing marketing and anti-kickback compliance.
Long-term care facilities
face significant compliance challenges as they are subject to both federal and state regulation. We are a leader in this field and have represented the interests of various long-term care providers including skilled nursing facilities
, adult residential facilities, adult day health centers, inpatient behavioral health facilities, hospices, rehabilitation facilities and assisted living
/residential care facilities for the elderly. Nelson Hardiman’s experience in this area has also led to our function as compliance officers for more than 50 such facilities. We have also defended our clients before state and federal enforcement agencies ranging from the California Department of Public Health, California Department of Justice and Centers for Medicare and Medicaid Services. Given our nation’s aging population and increasing number of chronic health conditions, long-term care facilities will continue to draw more and more scrutiny by regulators in the future.
Healthcare Regulatory Compliance
Whether you seek a general healthcare compliance attorney or are interested in targeted advice regarding discrete issues such as Stark/Anti-Kickback compliance
, HIPAA compliance, FDA compliance or hospice compliance
, we’ve got you covered. Our attorneys routinely work with a variety of provider types and entities to address ongoing issues and design feasible compliance strategies going forward.
Physician Contracts & Physician Employment Agreements
As part of our deep transactional practice, Nelson Hardiman is routinely called on as a physician contract lawyer. For example, we can assist with drafting and/or commenting on physician employment agreements, medical directorship agreements, and physician services agreements. We also provide consultation regarding contract negotiations to flag possible compliance issues and ensure that unfavorable or hidden responsibilities are not inadvertently accepted.
We “Get” Hospital Reimbursement
is an area in which even the best, most well-run hospitals tend to suffer. While in-house collection teams can be effective in the initial stages of appeal, in our experience they are often overwhelmed by the various strategies and tactics employed by both public and private payors to not pay, underpay, or claim they’ve overpaid hospital claims. At Nelson Hardiman, we have seen it all. Whether you need help with Medicare or Medi-Cal appeals
; or instead seek payment from contracted or non-contracted private payors, including health insurances or managed care plans, we are ready to assist. Our track record on this front speaks for itself. Our attorneys have represented numerous hospitals in civil litigations, arbitrations and administrative hearings to obtain additional reimbursement and defend claims of overpayment. This includes suits and arbitrations against the largest insurance and managed care companies in both state and federal courts involving thousands of claims worth millions of dollars in additional reimbursement that would have otherwise been written off. Indeed, we are often surprised at how much potential reimbursement hospitals will “leave on the table” when dealing with uncooperative insurance and health plans. Let us help maximize your return on your claims so you can maintain your attention on providing quality care.
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