Primary Care Providers

primary care providerNelson Hardiman represents physicians who specialize in primary care and is known for its depth of experience in accomplishing the goals of its primary care provider clients. Primary care physicians continue to face new challenges from an ever changing medical, technological and regulatory landscape.  The resurgence of managed care has led to a long-term migration of physicians out of smaller private practices into larger managed-care, hospital-affiliated physician organizations, creating new operational and alignment issues for physicians. This shift has also been accelerated by the enactment of the Patient Protection and Affordable Care Act (ACA) which pushes providers away from the traditional “fee for service” model and towards shared savings in a more efficient, value based care environment, setting the stage for new models of delivering healthcare services including concierge practices and telemedicine.

At the same time, the ACA has precipitated an increase in demand for medical services which has strained the supply of physicians and led to continued concern over patient safety and fraud and abuse issues. As primary care physicians continue to service an ever growing patient population and explore new and collaborative health care delivery models, they must navigate through complex legal issues such as the Anti-kickback and Stark laws, HIPAA privacy compliance, and California’s ban on the corporate practice of medicine. Whatever the challenge, Nelson Hardiman has both the experience and resources to resolve the problems facing our primary care provider clients.
Nelson Hardiman has been called upon to counsel and represent primary care physicians in connection with various business and high stakes litigation matters. Whether you need to set up a compliant business model, negotiate a managed care contract, or are facing exclusion from a health plan’s “narrow network”, our attorneys are particularly poised to provide the representation necessary to meet your business, regulatory and strategic needs, including:

  • Business Transactions
    • Formation of professional corporations
    • Formation of management companies
    • Accountable care organizations (ACOs)
  • Regulatory Defense
    • Medical Board investigations
    • DEA audits and investigations
    • Reimbursement audits and investigations by private and government payors
  • Compliance
    • Corporate practice of medicine
    • Credentialing and peer review
    • Informed consent and patient agreements
    • Stark and Anti-Kickback Statute compliance
    • Medicare and Medi-Cal compliance
    • HIPAA and state patient data privacy and security requirements
    • Audit risk assessment
  • Litigation
    • Licensure defense and appeals
    • DEA license appeals
    • Medicare and Medi-Cal appeals
    • Payor and reimbursement disputes
    • Overpayment appeals
    • False Claims Act / Qui tam whistle-blower litigation defense
    • Business and employment litigation
    • Medicare and Medi-Cal exclusions and suspensions