Independent Physician Association (IPAs)

Nelson Hardiman represents independent physician associations (IPAs) in their business, regulatory, and strategic challenges, including:

  • Business Transactions
    • Formation of entities and business structure for IPAs
    • Knox-Keene and Department of Managed Health Care (DMHC) solvency requirements for risk-bearing organizations
    • Negotiation of payor contracts
    • Management Service Organization (MSO) relationships
    • Purchase and sale of IPAs
    • Network and physician contracts
  • Regulatory Defense
    • Medical Board investigations of IPA practices
    • DMHC audits and investigations
    • Reimbursement audits and investigations by governmental payors, including Medicare and Medi-Cal
  • Compliance
    • Stark and Anti-Kickback Compliance
    • Compliance with utilization review requirements
    • Knox-Keene compliance counseling
    • HIPAA and state patient data privacy and security requirements
  • Litigation
    • False Claims Act/qui tam whistle-blower litigation defense
    • Payor and reimbursement disputes
    • Disputes regarding exclusive provider contracts
    • Disputes related to transactional misrepresentations
    • Business litigation, including shareholder disputes