Medical Groups

medical groupNelson Hardiman attorneys have decades of experience assisting physicians in forming multi and single specialty medical groups, and have served as tireless strategists and advocates for medical groups as they navigate complex operational, reimbursement and alignment issues.  Our experience on behalf of medical groups runs the gamut, and includes crafting the medical group’s essential organizational and governance documents, dealing with management and employment issues, negotiating contracts with hospitals and health systems, negotiating managed care contracts, pursuing reimbursement owed to the medical group, defending against government audits and over-payment actions, and resolving the occasional peer review and business dispute that arises between the group and its physicians.

Medical groups and independent practice associations (IPAs) have long been utilized by physicians to respond to the challenges of managed care.  The incentives for collaboration, integration and alignment have only increased with the enactment of the Patient Protection and Affordable Care Act (ACA), which has resulted in new alignment models such as accountable care organizations (ACOs) that are of great significance to physicians and medical groups. As medical groups explore new collaboration and alignment models, they must grapple with complex legal issues such as California’s prohibition against the corporate practice of medicine, antitrust laws, the Anti-kickback and Stark laws, and a new reimbursement landscape. Nelson Hardiman has deep experience in all of these areas, and over the years has had the opportunity to address and resolve a variety of problems for medical groups that are struggling with how to position themselves for success in a rapidly changing regulatory and reimbursement landscape.

With decades of combined experience, our attorneys have formed and have represented every iteration of the group practice model, including expense-sharing arrangements, physician management service organizations (MSOs), multispecialty and specialty IPAs, and large fully-integrated medical groups.  We have been called upon to handle the most sensitive of challenges, including designing compliance programs and corrective action plans in connection with government investigations, and high-stakes litigation with large hospital systems involving potential displacement of the group practice by “medical foundation” clinics.

Our work for medical groups extends across a wide range of business, regulatory, and strategic challenges, including:

  • Business Transactions
    • Formation of professional corporations
    • Formation of management companies
    • Purchase and sale of medical practices
    • Network and physician group contracts
    • Managed care contracts
    • Hospital and ASC contracts
  • Regulatory Defense
    • DEA investigations and defense
    • Peer review and medical staff
    • Reimbursement audits and investigations by governmental payors and SIU departments
      • Medicare
      • Medi-Cal
      • Safeguard Services
      • Palmetto GBA
      • Office of the Inspector General
      • Commercial insurers
  • Compliance
    • Corporate compliance programs
    • Corporate practice of medicine
    • Stark and Anti-Kickback Statute Compliance
    • Medicare and Medi-Cal compliance
    • HIPAA and state patient data privacy and security requirements
    • Physician extenders and scope of practice
      • Nurse practitioners
      • Medical assistants
      • Physician assistants
      • Audit risk assessment
      • Employment law
  • Litigation
    • Credentialing and peer review disputes
    • Licensure defense and appeals
    • Medicare and Medi-Cal provider enrollment appeals
    • Payor and reimbursement disputes
    • Overpayment appeals
    • False Claims Act/ Qui tam whistle-blower litigation defense
    • Business and employment litigation
    • Trade secrets, unfair compensation and tortious interference
    • Medicare and Medi-Cal exclusions and suspensions