Skilled Nursing/Post-Acute

Nelson Hardiman represents California skilled nursing facilities in their business, regulatory, and strategic challenges, including:

  • Business Transactions
    • Formation of entities and business structure
    • Network and physician contracts
    • Negotiation of payor contracts
    • Purchase and sale agreements
    • Service agreements and vendor contracts
      • Ambulance companies
      • Durable medical equipment companies
      • Pharmacies
    • Employment and independent contractor agreements
  • Regulatory Defense
    • Department of Public Health (“DPH”) licensure investigations
    • Reimbursement audits by private and governmental payors and their contractors
      • CMS
      • Medicare
      • Medi-Cal
      • Palmetto GBA
    • Fraud and abuse investigations by government payors and their contractors
      • Safeguard Services
      • Office of Inspector General
      • Federal Bureau of Investigations
      • Department of Justice
      • Department of Health Care Services
      • Bureau of Medi-Cal Fraud and Elder Abuse
    • Audit defense
      • Zone Program Integrity Contractor (“ZPIC”)
      • Recovery Audit Contractor (“RAC”)
      •  Program Integrity Safeguard (“PSC”)
  • Compliance
    • Licensing, operational, and reimbursement compliance
    • Medicare and Medi-Cal enrollment and changes of ownership
    • HIPAA and state patient data privacy and security requirements
    • Regulatory audits and corrective action plans
      • Licensure citations and deficiencies
      • Medicare and Medi-Cal regulations
      • Prepayment review
    • Local Coverage Determination compliance and medical necessity audits
      • Skilled nursing services
      • Rehabilitation therapy services
      • Psychiatric diagnoses
    • False Claims Act compliance audits and solutions for marketing and business development activities
  • Litigation
    • Provider enrollment and claims appeals
    • Overpayment appeals
    • False Claims Act/qui tam whistle-blower litigation defense
    • Business and employment litigation
    • Exclusion and suspension appeals by government entities, including the Department of Health and Human Services Office of the Inspector General and California Department of Health Care Services