Top Lawyers: Harry Nelson of Nelson Hardiman On The 5 Things You Need To Become A Top Lawyer In Your Specific Field of Law

From the article:

As a part of this interview series, I had the pleasure of interviewing Harry Nelson.

Harry, the founder of Nelson Hardiman, has been called the leading healthcare lawyer in America. Apart from his regulatory strategy work in other areas of healthcare and life science innovation, he developed the regulatory pathway for telehealth companies that were acquired in 2021 for collectively over $2 billion. His lessons from crisis response work in the overdose crisis led to the best-selling “United States of Opioids: A Prescription for Liberating a Nation in Pain.” Harry’s advocacy work related to America’s healthcare future has led to numerous awards and has produced tangible results to improve healthcare regulations at the federal and state levels.

Thank you so much for joining us in this interview series. Before we dig in, our readers would love to get to know you a bit more. What is the “backstory” that brought you to this particular career path in Law? Did you want to be an attorney “when you grew up”?

Can you tell us a bit about the nature of your practice and what you focus on?

My practice has 3 sides. For companies in areas of healthcare and life science innovation, like telehealth, behavioral health, genomic testing, stem cells, psychedelics, I function as a regulatory lawyer and strategist, helping early stage ventures navigate uncharted or less charted regulatory waters from ideation to all the way to wherever they want to go. For healthcare and life science companies in crisis due to regulatory mistakes (fraud, patient safety, privacy violations or other noncompliance), I help them fix what is broken — remediating compliance issues, repairing relationships internally, with government agencies, with insurance companies. And for many healthcare companies, I serve as a one- stop shop when they need outside regulatory counsel for ongoing business needs.

You are a successful attorney. Which three character traits do you think were most instrumental to your success? What unique qualities do you have that others may not? Can you please share a story or example for each?

I don’t think I would be where I am if I wasn’t driven. Life would be more fun if I wasn’t constantly driven to work relentlessly to produce the highest quality work product and advice, and to be the best. I would set better boundaries. My wife and my kids are ready to kill me sometimes because I am rarely fully away from the work. I will be on the ski lift with my kids and a client has an issue, and I am in the thick of it. I get a complete separation only from Friday night to Saturday night because we observe Shabbat, but I think that indefatigable drive is the number one thing that separates me from my colleagues.

I think my empathy has been a difference-maker. I once had a doctor who kept calling me. He lived on the other side of the country, but had gotten my name from a friend. He told me from the beginning that he was already working with two other lawyers I knew and respected, one of whom was nationally renowned, but I took his calls as a courtesy and then took a meeting with him. I kept telling him, “You’re in good hands already. You don’t need me.” He said to me, “I did my homework and I know I’ve hired the best people. But I also know that you are every bit as good as they are. And the difference is, when I talk to them, they leave me cold. But when I talk to you, I feel you are in it with me, and my anxiety just lifts.” It was an epiphany for me that part of my difference is that personal bond and my ability to give clients emotional support in a way other lawyers didn’t. He taught me not to hold back, to lean in to the emotional side of a client’s needs.

I think that my ability to manage stress and to process things quickly has been a key difference. I work in areas of law where the norm for lawyers is to be super-cautious and slow, and I know it drives clients crazy. There’s way too much hemming and hawing because it’s stressful to stake out a definitive position in areas where technology has outpaced the law, and where there’s confusion and ambiguity. I have come to the view that, as long as I am transparent about what I know and where I am thinking out loud, I can give clients my best advice in a way that is specific and in real-time, without making them wait for a memo a couple weeks later. I regularly have clients who tell me, “I spent the last six months and tens of thousands of dollars with other lawyers getting the run around, and you just gave me the answer on our very first call.” It only happens because I can manage the stress of being put on the spot constantly, process the situation, the challenge, calibrate to the audience, and give the answer that is needed.

Do you think you have had luck in your success? Can you explain what you mean?

I have unquestionably had some good breaks that you could call lucky. I was once standing in line at a hotel valet parking waiting for my car after an event, when a lawyer I knew from another firm walked by with a colleague and introduced me. That introduction produced one of my biggest clients of the past decade. I view the kindness of people on a daily basis who happen to think of me and make connections as the greatest kind of luck.

I’ve come to the belief that everything happens for a reason, that we can’t understand why good things happen or why bad things happen. All we can do is be grateful for the breaks we get and find a way not to hold onto anger and resentment with the ones that don’t go our way. I’ve got a way to go on that score, but I have learned to process things quickly so that I can move on and focus on the next thing.

Do you think where you went to school has any bearing on your success? How important is it for a lawyer to go to a top-tier school?

I am proud of being a Michigan alum. I think it mattered at the beginning of my career that it was a top school. It helped me get a clerkship with a judge in Hawaii, who maybe only gave me an interview because he was Michigan alum. It helped with my first job at a firm in Chicago, at a firm with other people from elite schools, having the right markers on my resume. But I know as many lawyers without fancy academic pedigrees who were as or more driven than me that have killed it. It definitely gives you a leg up in the early days of your career, but I also think over time, it really doesn’t matter where you went to school. And what I have seen being in Los Angeles is that it may be just as valuable to have a network of local alumni (be it USC or Loyola) than to have high- ranking school without a strong presence in the community.

Based on the lessons you have learned from your experience, if you could go back in time and speak to your twenty-year-old self, what would you say? Would you do anything differently?

I would say a few things:

First, I would say there are times I should have been more patient. I sold a big position out of Amazon when Webvan cratered that I can’t even think about. Hang in there on those bets.

Second, I would say it took me a while to really have fun with the work, to be myself fully, to feel a sense of not just purpose, but joy. I think my early days as a lawyer were too focused on making the senior folks I worked for happy, to meeting expectations, and not focusing on setting up the life that I wanted. I worried too much about what other people thought and not enough about what I needed. I would tell my younger self not to waste time getting to know my interior self and to embrace my work style, my risk tolerance, and my passions. I would spend more time with fellow creatives and people who are energizing.

Third, I would tell my younger self not to worry so much about fitting in. Law is a crowded marketplace where not standing out is basically the same as being invisible.

This is not easy work. What is your primary motivation and drive behind the work that you do?

It constantly changes. There was a point where I was convinced I was building an empire, a national practice and leaving a legacy. All it took was a taste of what mercenary times these are for so many lawyers for me to be dissuaded that that was a worthwhile pursuit.

There is a piece that is motivated by the satisfaction of providing for my family, of taking care of the people I love, of having the autonomy to make my own choices.

But I think my ultimate motivation is that I feel I am living my purpose when people bring me problems to solve, and I am able to work them out. I feel a sense of joy in connecting with people on the work, in learning of something new about feeling a momentary satisfaction about a job well done — before jumping into the next problem.

What are some of the most interesting or exciting projects you are working on now?

I have a handful of clients that feel like multi-billion dollar opportunities if they can work out the challenges in front of them. I am particularly excited about two projects I am working on at the cutting of personalized, genomic medicine that I think is about to revolutionize medicine. I am excited about a couple of clients who are at the forefront of psychedelic therapy, including one that is integrating psychedelics into telehealth to drive a transformation in how we treat depression and PTSD. I am really excited about a local health system client that is on the verge of rolling out a new model of behavioral health crisis response centers that have the potential to move the needle on overdose prevention and also on addressing homeless mental health issues.

Where do you go from here? Where do you aim to be in the next chapter of your career?

I am really enjoying myself these days. And I still feel passionate and energized by the work I try to make sure I am focusing on doing what I love, doing it well, staying on top of the next big things.

Beyond my practice, I am working with a publisher on a new book addressing America’s overdose crisis. I’ve been asked to get involved in some more television projects, and am trying to figure out a roadmap to make sure my public service messages for America’s healthcare future are being heard. I have gotten some informal inquiries about taking a leadership role in some type of (appointed, not elected) public service. I am taking interesting calls and keeping my ear to the ground.

I haven’t figured out what the next chapter is for me. I am trying to build up a strong cadre of colleagues who can bear more of the “heavy lifting” in client work that I currently do, so that I have the option to re-allocate more time to other projects, but that is a work in progress.

Without sharing anything confidential, can you please share your most successful “war story”? Can you share the funniest?

My favorite war stories involve jumping in at the last minute into projects that couldn’t be resolved by other people and taking care of business. I once got a call from the general counsel of one of the biggest telehealth companies in the country. He was panicked because the Medical Board of California was about to commence a hearing against one of their doctors. Their regular law firm handling the case had reassured them the matter would be settled on mutually agreeable terms, and then informed them that they were wrong, and there was no way to prevent the case from going forward in just over a week. The Deputy Attorney General handling the case was an impossible, ideological person, on a mission, who I had butted heads with before, and I knew she was never going to give ground. So I went over her head and made a direct appeal to the Board leadership and painted a picture of why this case needed to be shut down. Less than 24 hours before the case was scheduled to start, with the doctor about to board a plane to come to California, the case was dismissed. No explanation. Grateful client, very unhappy prosecutor.

My other favorite war story is that I had a publicly traded client in a different area of healthcare being railroaded out of California by a licensing agency. They had many locations, and it was going to be a disaster for them. I decided that the case needed a new lawyer, but that it would be better for me to bring in another law firm so I could serve as the expert witness. The strategy paid off when the administrative law judge found in his decision that I was the authoritative person on the issue in question (corporate practice medicine), as exemplified by the number of times that the Attorney General’s office kept citing me. He wouldn’t let them pick and choose. It was a case with hundreds of millions of dollars at stake for the client, and my testimony won the case. The state agency adopted it and abandoned a multi-year battle with the company.

The funniest story for me was the one that led me to become the very first healthcare lawyer in the country to start doing medical marijuana work. In 2009, the Obama Administration had just announced it would stop raiding California’s medical marijuana dispensaries if they complied with state guidance. I was known for my DEA-related work, including petitioning for DEA research permits for cannabis, so my phone started ringing off the hook with marijuana-related clients. I said, “I don’t really know much about medical marijuana law beyond doctors. Let me find the right lawyer who understands dispensaries, cultivation, product development. I called around and found the lawyer everyone in town described as the expert. Everyone else advising was a criminal defense lawyer, but this was the preeminent “corporate lawyer” for cannabis in California. I left a voicemail message for him. He called me back and we had a nice conversation late in the day. I was getting ready to email the people who called me his name the next day, when he called me again. He literally had no recollection whatsoever that we had already spoken. I realized he had been as high as a kite in both conversations. I decided I couldn’t in good faith give his name to anyone, so I decided to roll up my sleeves and start learning cannabis. Within a year, we had the biggest cannabis practice in Southern California. The lawyer later became a client and a friend, but to this day, I credit him with inspiring me to tackle the space.

Ok, fantastic. Let’s now shift to discussing some advice for aspiring lawyers. Do you work remotely? Onsite? Or Hybrid? What do you think will be the future of how law offices operate? What do you prefer? Can you please explain what you mean?

Personally, I like to be in the office. It’s quiet these days (more than half of our team is still remote), but I like the ability to bounce ideas around with my colleagues who are there. The work is getting done, but I would say some of the emotional support and connection we give each other is gone when everyone is remote. I also think it is weakening our culture and the bonds that tie us together. I already hate how mercenary law practice has become, and I think this makes it worse. I am trying to make the most of it personally by traveling more, taking advantage of the ability to be someplace else, stretching out my time away. I think it is the future. We have 42,000 square feet of space and can function with a fraction of it in the post-pandemic world. I would not want to be in the commercial real estate business. Law firms are going to get much more space efficient, and I think we are going to see a wave of innovation in digital tools to let u better connect remotely.

How has the legal world changed since COVID? How do you think it might change in the near future? Can you explain what you mean?

There have been some positive changes. I used to have many projects that needed an in-person meeting to get going. These days, everyone is just fine with an initial meeting or a kick-off via Zoom. I think location matters less than ever. We are getting new clients all over the country and also globally more than ever. At the same time, we are competing with good lawyers and firms all over the country, so it forces us to up our game. As a healthcare lawyer, COVID has also brought up many new legal issues for us to tackle, and driven the growth of pandemic-friendly businesses, like diagnostic lab testing and telehealth that were already sweet spots for us.

We often hear about the importance of networking and getting referrals. Is this still true today? Has the nature of networking changed or has its importance changed? Can you explain what you mean?

I would be nothing without an amazing network of lawyers at other firms and former clients who give my name out all over the place, who vouch for me, and who sing my praises when people need someone who does what I do. So networking is still critical to me. The pandemic put our ability to nurture our networks on hold, because we stopped seeing each other, and were limited to more impersonal emails and calls. I have had a slight advantage with regular TV appearances because I tend to be highly visible on social media so people don’t forget about me. But networking in person will be a big focus again with COVID hopefully in check.

Based on your experience, how can attorneys effectively leverage social media to build their practice?

It keeps evolving. At one point, I had massive visibility on LinkedIn, and then they changed their algorithm, and I went from thousands of views per day to several hundred per week. I have had good results with Facebook, although I am still learning. I feel like I am still at square one in learning how to use Instagram for engagement. I think of social media as a visibility tool which is useful for activating my network. The work flows mostly through the network, but the social media visibility keeps me on the network’s mind.

Excellent. Here is the main question of our interview. What are your “5 Things You Need To Become A Top Lawyer In Your Specific Field of Law?” Please share a story or an example for each.

1. Research: You are dead in the water in healthcare law if you aren’t on top of the latest regulation or pronouncement in whatever jurisdiction you are dealing with. The ground is constantly shifting. I’ve picked up more than a few clients because their last lawyer missed a particular change. For example, after Medicare announced the 36-month rule limiting home health agency changes of ownership, I saw an influx of work because one of our competitors had failed to advise client that it was coming.

2. Writing: I am in the business of persuading investors or acquirers of early stage ventures that the regulatory compliance concerns expressed by other lawyers are not a real problem — or that they are addressable. I am constantly relying on my ability to write to win hearts and minds and get deals done. Just last week, we had a national law firm ready to kill an acquisition of one of our clients over an expressed compliance concern. I generated a memo that convinced the other firm’s client that they were being unduly conservative. This work is all about the writing.

3. Speaking: There are many moments when being able to deliver the message clearly and succinctly is the difference between success and failure. I have been though a number of eleventh hour conversations where being confident and firm makes the difference as to whether the deal gets done or not.

4. Problem-Solving: So much of the work is figuring out the best way to navigate through the puzzle. People call us when they are stuck or confused or lost. The job comes down to knowing the landscape and then thinking critically, thinking creatively, and thinking quickly, because something bad is going to happen if we don’t figure out the solution and get it done.

5. Interpersonal: I don’t see how you can be successful if you can’t listen, relate to clients and make them feel heard and understood. People need to really be able to trust and rely on their lawyer on sensitive healthcare questions.

We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might see this. 🙂

I get to interact with more sports and entertainment celebrities than you might think who are considering or joining cutting edge healthcare/life science ventures, and my job is to settle down VCs so clients can get the funds they need. If I had to confess a fascination, I would love a chance to schmooze with Elon Musk. I love his drive to innovation and would like to sell him on some life science opportunities. Slightly geekier second choice would be to pick Ray Kurzweil’s brain. I have a lot of questions for him.

This was very inspiring. Thank you so much for the time you spent with this. We wish you continued success and good health!

_______________________________________

Contact: [email protected]

 


Client Alert: MultiPlan Named As Central Figure In Antitrust Lawsuit Alleging Health Insurance Monopoly Scheme

The liquidating bankruptcy trust for Verity Health System of California recently filed a lawsuit in the Superior Court of the State of California, County of San Francisco, against third-party “re-pricer” MultiPlan, including its subsidiaries Viant and Data iSight, and more than a dozen of MultiPlan’s customers – including major commercial payers like Anthem, United Healthcare, Aetna, Cigna, and others – alleging antitrust claims under California’s Cartwright Act and Unfair Competition Law.

According to the lawsuit, MultiPlan acted as an unlawful “corporate hub” of a classic “hub, spoke, and rim” agreement among the re-pricer and its various insurance company clients, to “fix” the amounts that would be reimbursed to healthcare providers on out-of-network claims. The complaint alleges that reductions in reimbursement payments for healthcare services rendered by providers nationwide totaled approximately $10 billion per year from 2012 to 2020, driving up profits for MultiPlan’s insurance company clients, and also for MultiPlan itself.

Indeed, the timing of the lawsuit is significant, as it comes on the heels of MultiPlan recently going public in one of the largest transactions of its type ever, with an $11 billion company valuation.

Regarding the scheme at the center of the lawsuit, the complaint alleges that MultiPlan entered into a series of contracts with the various commercial payers, by which MultiPlan was paid to provide the commercial payers with the same artificially deflated payment data, which the commercial payers would all in turn utilize to reimburse their out-of-network healthcare providers at the same reduced rates. According to the complaint, MultiPlan’s commercial insurance customers implemented the identical MultiPlan-set reimbursement rates nearly all the time, and due to MultiPlan’s dominance in the industry, and the imbalance of power between individual healthcare providers and MultiPlan’s stable of insurance company clients, providers have bothered to appeal the MultiPlan rates only about 5% of the time going back to 2011. As the complaint puts it, healthcare providers “have no choice but to accept those prices, given the conduct at issue in this Complaint, as resistance would be futile.”

This lawsuit and its potential effect on the healthcare industry is reminiscent of the industry shake-up that occurred over ten years ago. In 2009, following an intensive investigation, the New York Attorney General’s Office issued a Report and subsequent enforcement action against then-United Healthcare subsidiary Ingenix that found that Ingenix “gathers billing data from the largest health insurers in the county . . .and then sends back schedules to these health insurers and others, based on the pooled data, which the insurers use . . . to set their reimbursement rates.” The Report further noted that the Ingenix databases “understate[d the] market rate by up to 28 percent [and caused] at least hundreds of millions of dollars in losses” for providers and consumers of the prior ten years. The New York AG’s Office forced the shut-down of Ingenix and helped pass a New York law prohibiting commercial insurers’ use of affiliated “repricing” businesses. The New York AG actions likewise led to several class action lawsuits, resulting in settlements totaling more than $2 billion.

These claims of “Monopoly!” will likely resonate with healthcare providers of all types and practices, who have long felt powerless in the face of the increasingly behemoth insurance industry. That MultiPlan may now be at the center of it all is probably no surprise to many. Whether this new lawsuit – significantly, a private action as compared to the New York Attorney General’s Office investigation of Ingenix – can yield similar results remains to be seen. But the wheels have been set in motion, and perhaps this lawsuit will result in substantial movement towards a more equitable reimbursement model.

We invite you to contact us with any additional information you have obtained regarding this important matter.

Authored By:

Zachary Rothenberg  E:[email protected]

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*This article is provided for educational purposes only and is not offered as, and should not be relied on as, legal advice. Any individual or entity reading this information should consult an attorney for their particular situation.*


Fight to Free Britney Spears Highlights ‘Toxic’ Side of Conservatorsh

The legal arrangements are meant to protect people unable to make their own decisions. A burgeoning movement sees it as a vehicle for abuse.

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For questions please contact: [email protected]

*This article is provided for educational purposes only and is not offered as, and should not be relied on as, legal advice. Any individual or entity reading this information should consult an attorney for their particular situation.*


Debate on vaccine mandates leaves mental health providers conflicted

Mental Health Weekly interviewed Partner Rob Fuller regarding the decision on whether to mandate COVID-19 vaccination for staff members and the public health concerns against the reality of workforce shortages.

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For questions please contact: Rob Fuller

*This article is provided for educational purposes only and is not offered as, and should not be relied on as, legal advice. Any individual or entity reading this information should consult an attorney for their particular situation.*


California sets Vaccine Mandate For Healthcare Workers and Visitors

Order broadly applicable to hospitals of all kinds, skilled nursing, adult day health centers, ambulatory surgery centers, doctors offices and clinics, residential substance abuse facilities, and others.
California issued orders over the past week (i) mandating healthcare workers become vaccinated, and (ii) mandating all hospital and long-term health facility visitors show proof of vaccination or recent negative Covid test.  The implications of these orders for health care enterprises are wide-ranging, requiring additional human resources processes and front door processes to address the new demands to check vaccination status of workers and visitors.

I.          Vaccinations Required for Workers in Healthcare Facilities

California Department of Public Health (“CDPH”) issued an order on August 5th, requiring healthcare workers who provide services in or have the potential for direct or indirect exposure to patients in hospitals, skilled nursing facilities, and other healthcare facilities to be vaccinated  no later than September 30, 2021.

 A.  Facilities covered by the order

The order applies to “healthcare facilities” and “workers.”  These definitions are broad. “Healthcare facilities” covers acute, subacute, and behavioral health facilities, including:

  • General Acute Care Hospitals
  • Skilled Nursing Facilities
  • Intermediate Care Facilities
  • Acute Psychiatric Hospitals
  • Adult Day Health Care Centers
  • Program of All-Inclusive Care for the Elderly Centers
  • Ambulatory Surgery Centers
  • Chemical Dependency Recovery Hospitals
  • Clinics & Doctor Offices
  • Congregate Living Health Facilities
  • Dialysis Centers
  • Hospice Facilities
  • Pediatric Day Health and Respite Care Facilities
  • Residential Substance Use Treatment and Mental Health Treatment Facilities

B.  Workers covered by the order

Similarly, “Workers” is an all-inclusive definition, not limited to just employees, covering employees, contractors, vendors, and volunteers, who are physically present wherever care is given or wherever patients have access in a healthcare facility.  Workers include all people who are indoors who share space covered by common air handling, covering clinicians of all types, technicians, therapists, students, trainees, contractors not employed by but present in the healthcare facility, and persons not directly involved in patient care, but who are present in patient care and patient access areas, such as clerical, clergy, dietary, environmental services, laundry, security, engineering, facilities operations, administrative, billing, vendor, and volunteer personnel.

C.  Limited exemptions

There are limited exceptions based on bona fide religious beliefs and medical reasons.  Exemption from the vaccination mandate may be sought through the worker submitting, in the case of the religious belief exemption, a signed form declaring opposition to the vaccine based on religious beliefs, or, in the case of medical exemption, a letter from a physician documenting that the worker has a “Qualifying Medical Reason” for not receiving the vaccine.  To be eligible for a Qualifying Medical Reason exemption, the worker is required to provide the physician’s letter stating that the worker qualifies for the exemption under the terms of the order, but not necessarily documenting the underlying medical condition that constitutes the Qualifying Medical Reason. The letter should also state anticipated duration of the worker’s inability to receive the vaccine or whether the duration is permanent.

Employers who accept the exemptions must ensure that exempt workers are (i) screened for fever and other symptoms when reporting to work, (ii) tested weekly or biweekly for COVID-19, and (iii) required to wear a surgical mask or respirator at all times while at work. Testing may be either polymerase chain reaction or antigen tests. Testing is required twice weekly for exempt workers in acute health care and long-term care facilities, and once weekly for all other healthcare settings.

D.  Facility recordkeeping requirements

Facilities subject to the order are required to make and retain a record of workers’ vaccination pursuant to CDPH guidelines (available at: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Vaccine-Record-Guidelines-Standards.aspx).  These guidelines require the facility to record (i) Worker’s name and date of birth; (ii) date of vaccinations and vaccine manufacturer; or, if not vaccinated, (iii) documentation supporting the exemption and the ongoing lab test results. Such records should be treated as Personal Health Information maintained on a confidential basis.  Local or state Public Health Officers or their designees are empowered to review and audit such records which must be provided promptly upon request (no later than one business day).

E.  Interaction with prior order

The CDPH August 5 order does not replace or supersede its earlier July 26 order, that allowed testing and masking as an alternative to vaccination.  The requirements of the July 26 order remain in place until September 30 (including vaccination status checks and periodic testing unvaccinated workers or workers whose status is uncertain), at which time the ‘test and mask’ alternative to vaccination will no longer be an option.


II.        Vaccinations required for Hospital and Long-term Care Facility Visitors

Effective as of August 11th, a separate CDPH August 5 order prescribed strict limitations on visitors to hospitals and long-term care facilities.  The order is applicable to general acute care hospitals, skilled nursing facilities, and intermediate care facilities.  The order covers only indoor visitation.

The facilities covered by the order must either: (i) verify visitors are fully vaccinated, or (ii) for unvaccinated or incompletely vaccinated visitors, verify documentation of a negative COVID test within the prior 72 hours. Facilities must track visitors in the facility, and record and retain documentation of the vaccination record or negative test.

There is a limited exception where the visitor has neither proof of vaccination or negative test, when the visitor is seeking to visit a patient in critical condition, “when death may be imminent.”  Such exempt visitors are required to physically distance and wear PPE.


III.       Impact of Recent Orders

From a practical standpoint, these orders impose significant recordkeeping, monitoring, and human resources requirements on covered facilities.

Under applicable CDPH and CalOSHA orders, entry screening continues to be required for all employees and visitors, and, in addition, covered facilities must provide a mechanism for visitors to submit their vaccination and/or negative test results, and record such documentation.  These requirements for visitors start on August 11. Facilities must also have a mechanism for monitoring visitors as they enter and transit through the facility, including prominent identification that they are a visitor and their intended destination within the facility.  Employees should be trained to address any visitor in areas not their intended destination or in transit thereto.

Human resources departments, in conjunction with employee health in larger facilities, must establish secure processes to obtain and maintain records of all employee vaccination and exemption records.  More problematic is addressing which internal entity should be responsible for establishing similar processes for contractors, vendors, and volunteers.  Most larger facilities will establish protocols for human resources expand their operations to cover such non-employees in order to have a centralized record of vaccination status and/or exemption and test results.  Whichever department(s) is/(are) established to collect the data, a centralized, secure data base or filing system should be created to allow for ease of response in the event of an audit by the public health authorities.

Administration, human resources, and security departments must develop plans and protocols for addressing non-compliant employees, contractors, vendors, and volunteers.  Whether an employee is terminated for non-compliance or placed on administrative leave pending completion of vaccination or exemption process should be considered on a case-by-case basis to ensure compliance with employment laws and/or union agreements.  But it is clear that non-compliant persons of any type must be denied entry into the facility until they become compliant or are terminated.

If you have any questions about the recent orders, or the issues they raise in your operations, please contact us (310)203-2800.

Authored By:

Rob Fuller

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*This article is provided for educational purposes only and is not offered as, and should not be relied on as, legal advice. Any individual or entity reading this information should consult an attorney for their particular situation.


Modern Healthcare: UnitedHealth’s limits on out-of-network care seen as surprise billing ban reaction

Nelson Hardiman Partner Zachary Rothenberg was quoted by Modern Healthcare regarding UnitedHealth’s new limits on out-of-network care.

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The big insurer unveiled restrictions on out-of-network coverage just days before CMS published an interim final rule banning much surprise billing.

UnitedHealth Group’s decision to end some out-of-network coverage caught providers by surprise, with many speculating the move is part of a broader set of policies by the nation’s largest insurer aimed at controlling costs and lowering provider reimbursement. Starting July 1, UnitedHealthcare no longer pays out-of-network claims when fully insured customers seek non-emergency care outside of their local coverage area. Patients seeking treatment from “step down” facilities away from where they live, including skilled nursing homes, residential treatment facilities, inpatient rehabilitation programs and more, are subject to the new rule. Coverage areas typically include the entire state and surrounding states where patients reside.

“Anyone currently receiving treatment will be allowed to continue their treatment without disruption,” a UnitedHealthcare spokesperson wrote in an email. The company instituted the change as a way to reduce costs and improve quality care, according to the spokesperson. United rolled out the policy to a select number of fully insured employer plans and individual market health products, which must fully adopt the new restrictions by mid-2022. The insurer notified providers of the new policy in June, just days before CMS published an interim final rule implementing the surprise billing protections President Joe Biden enacted this year. “Over the course of a couple of days, we just started getting call after call from people freaking out about it,” said Zachary Rothenberg, a partner at the Los Angeles-based law firm Nelson Hardiman, which represents a number of behavioral health providers. “The rumor mill, as you can imagine, is hot.”

Healthcare providers are worried about the short-term impact on their patients, since the rescinded coverage affects those who currently are in facilities and have received pre-authorization for treatment, as well as the long-term impact on their revenue and the precedent it could set for other payers, Rothenberg said.

In the case of substance use disorder, patients frequently leave their coverage areas for treatment, because removing themselves from their current environments can result in better clinical outcomes, Rothenberg said.

Limiting patient options presents serious problems for people who need care, Rothenberg said. Nearly 120 million U.S. residents live in areas with shortages of mental health providers and only 27% of the population lives in counties with an adequate supply of mental health professionals, according to a 2020 report by the Kaiser Family Foundation. Many substance use disorder providers are clustered in specific areas, like southern California or Florida, Rothenberg said.

There’s no precedent to the new United Healthcare limits on out-of-network care based on geographical location, Rothenberg said. What’s more, United Healthcare can continue telling its employer clients that it provides out-of-network benefits and potentially offer them lower premiums even as it denies coverage to policyholders. The company currently is appealing a landmark behavioral healthcare case, Wit vs. UnitedHealthcare Insurance Company. A lower court ruling requires the insurer to reprocess 67,000 behavioral health claims and rewrite its coverage policies around behavioral health and substance abuse treatment.

“I would expect them to be chastened by that, but they’re really taking it even to an or more extreme level here,” Rothenberg said. “We don’t know if other major payers are watching and going to follow suit and if this is just the tip of the iceberg.”

The timing of UnitedHealthcare’s policy change can be credited to the rise in opioid misuse during the COVID-19 pandemic, said Bob Poznanovich, vice president of business development at the Hazeldon Betty Ford Foundation, based in Center City, Minnesota. Insurers also saw increased costs associated with profit-seeking rehab facilities increasingly partnering with “brokers” who identify and prey on prospective patients with insurance, with the aim of admitting those vulnerable individuals to their partner facility, he said.

“There have been fraudulent illegal, unethical providers that have emerged, many of which are emerged during the opioid epidemic, to take advantage of what they thought was the gold rush,” Poznanovich said The new United Healthcare policy could actually benefit patients because it ensures they only be seen by providers practicing evidence-based treatment, which will ultimately lower their cost of care, Poznanovich said. Out-of-network facilities can be twice as expensive for payers and patients and result in care that is half as good as in-network providers, he said.

As in-network providers for United Healthcare customers, the Betty Ford substance use disorder rehabilitation clinics stand to benefit financially from limitations on out-of-network coverage.

But by limiting patient choice, the insurer could saddle patients with bills for treatment that reach tens of thousands of dollars each week, said Caitlin Donovan, a spokesperson for the Washington-based National Patient Advocate Foundation. Bills for out-of-network services tend to be the largest among those patients submit to the foundation for assistance, she said.

The surprise billing regulation is the real reason for United Healthcare pulling back on out-of-network coverage, Donovan said. The rule bars surprise billing for emergency services and prohibits out-of-network charges for ancillary services, like those provided by anesthesiologists or assistant surgeons, along with other out-of-network charges when patients aren’t given advance notice. “With this new law, if they didn’t have this policy in place, they would then have to go in and bargain with those providers to get to a reasonable fee,” Donovan said. “That might be the whole problem.”

The insurance giant has been making bigger investments in providers and technology with an eye toward controlling costs.

By the end of the year, UnitedHealthcare aims to employ 56,000 physicians, making it the reportedly the largest physician employer in the nation. The company has also invested inNaviguard, which it describes as its “lead out-of-network offering” that employers can use to resolve disputes with providers. UnitedHealthcare developed Naviguard as an in-house replacement for MultiPlan, which brands itself as a healthcare cost-management company.MultiPlan is named in the Wit lawsuit suit as working with UnitedHealthcare to cover patients’ claims at below-market rates.

United Healthcare’s new out-of-network policy also allows it to pressure providers to join its networks and accept its reimbursement rates, said Adam Block, a health economist and founder of New York-based Charm Economics. “Providers are going to have to negotiate more in-network rather than use the out-of-network as leverage, because patients will no longer get a benefit of being able to go out-of-network, at least in some circumstances,” Block said.

The lines between self-insured and fully-insured policyholders continue to blur as the markets for them overlap. More smaller employers are choosing to self-insure, for example. Because of this, United Healthcare could face increasing pressure to reduce premiums for both blocs of business since the two types of plans are now competing with one another, Block said. The growing number of insurtech startups on the individual market could also be intensifying United Healthcare’s focus on cost-cutting, he said. “There will be more competition,” Block said. “What that means is an organization like United has to work harder to keep its business. This could be a response to that.”

________________

We invite you to contact us with any additional information you have obtained regarding this important matter.  Please stay tuned for further developments.

VIEW NELSON HARDIMAN ORIGINAL CLIENT ALERT

Authored By:

Daniel Eliav  E:Deliav@nelsonhardiman.com

Zachary Rothenberg  E:[email protected]

John A. Mills E:[email protected]

 

*This article is provided for educational purposes only and is not offered as, and should not be relied on as, legal advice. Any individual or entity reading this information should consult an attorney for their particular situation.


What’s next for Britney Spears’ conservatorship? Legal experts weigh in

Nelson Hardiman LLP’s Managing Partner Harry Nelson was asked to weigh in on the latest hearing regarding Britney Spears conservatorship by Fox News.

From the article:

After Wednesday’s bombshell court hearing, in which Britney Spears aired her concerns over the 13-year conservatorship that hangs over her, many are left with more questions than answers following the pop star’s address. In her testimony, Spears stated on the record that she didn’t feel she “was heard on any level” the last time she spoke to the court in 2019.

Fox News spoke with three experienced and well-versed attorneys, who are not involved in the legal matter, but lent insight into what could happen with Spears’ conservatorship considering the involved parties now have to go back to the drawing board and come to an agreement on what to do moving forward.

Meanwhile, attorney Harry Nelson, who is the founder and managing partner of the Los Angeles-based firm Nelson Hardiman, believes that Spears “can – and very likely will – end the conservatorship simply by filing a petition to terminate it and supporting the case that she made to Judge [Brenda] Penny.”‘

Nelson added that in his estimation, “the vast majority of conservatorships do not get terminated, simply because the conserved person is severely disabled or elderly and not in a position to mount a challenge once a conservatorship is imposed” but maintained that “it is not unusual for someone who has made meaningful strides in their self-management to request and obtain the lifting of a conservatorship.”

Full Article

Contact: [email protected]

About Nelson Hardiman

Nelson Hardiman LLP is the premier healthcare and life sciences firm in Los Angeles, serving healthcare providers, investors, and organizations that need a hard-to-find level of quality advice on the most sensitive industry issues. The firm’s litigation practice specializes in defending fraud and abuse and whistleblower actions, government investigations, reimbursement disputes, and other complex business disputes. Nelson Hardiman regularly serves as outside counsel for healthcare system clients and medical staff representation. Nelson Hardiman’s transactional group handles healthcare organization acquisitions, sales, investment, and financings, and Nelson Hardiman’s regulatory team advises on compliance with licensing, operational, and reimbursement issues across the full continuum of healthcare industry sectors, with expertise on Medicare and Medicaid requirements, privacy and data security, FDA, and many more matters. The firm has earned a singular position reputation nationally for its leadership in addressing issues in behavioral health. More information about the firm is available at www.nelsonhardiman.com or at 310.203.2800.


Client Alert: Optum Abruptly Cuts OON Benefits

Nelson Hardiman has obtained a copy of a notice that was recently circulated by Optum titled “Update to member service area coverage for OON benefits” (the “Notice”). In the Notice, Optum has announced a significant reduction to the availability of out-of-network coverage, set to take effect on July 1, 2021. Below we provide a short summary of the change, our concerns and questions raised by this unexpected announcement and, finally, some suggested actions.

Summary of the Change in Coverage

According to the Notice, the change will affect only UnitedHealthcare Fully Insured plans, to exclude members’ out-of-network (“OON”) benefits for services located outside of their service area. Notably, a “Fully Insured” plan under Optum’s terminology means a plan where the member is not covered by a self-funded employer plan, but rather that the insurer (i.e., Optum) pays for the services. The change will apply to medical and behavioral health services and impacts services that are already subject to prior authorization.

The Notice specifically calls out behavioral health exclusions for non-emergent, sub-acute inpatient or outpatient services received at any of the following facilities:

  • Alternate Care Facility – PHP or IOP
  • Freestanding Facility – Psychiatric or Substance Use
  • Residential Treatment Facility – Psychiatric or Substance Use
  • Inpatient Rehabilitation Facility – Psychiatric or Substance Use

While the Notice appears to be directed to in-network (“INN”) providers, it does not affect services provided by INN providers, who evidently can continue to admit and treat members of Fully Insured plans regardless of geography. Indeed, the Notice specifically advises that INN providers may be asked to accept Optum members who are currently at OON facilities that will no longer be covered once this change in coverage goes into effect.

Practice Concerns Presented by the Change

Despite Optum’s couching this change in policy as a “quality and cost-share” issue, it seems more likely to be strictly a cost-cutting measure, particularly given that the change applies only to Fully Insured plans where Optum is “on the hook” for the cost of care, but not to self-funded employer plans where Optum’s role to serve as an administrator of claims that ultimately are paid by the self-funded plans themselves.

As for providers, especially in the behavioral health space, they typically are either unable to secure contracts with payors like Optum despite efforts to do so, or they opt to stay out-of-network because they do not want to accept the lower reimbursement rates demanded by the major payors when contracting to be an INN provider. Staying OON offers flexibility to many providers who continue to treat OON members and collect more reasonable reimbursements that more closely align with the costs of providing services. Furthermore, many insureds intentionally choose plans that have OON benefits, paying substantially higher premiums, precisely because they want the flexibility of accessing providers who are outside the network and who may provide superior quality, convenience, or both. By cutting these benefits for services outside an insured’s “service area,” Optum is essentially cutting out a huge swath of providers and significantly limiting patient choice (while presumably continuing to collect the same, higher premiums paid by insureds who have chosen the freedom and flexibility of OON benefits).

Another underlying issue with the change in policy is that it allows Optum further control in dictating what treatment would be best for a given member. For example, a member of an Optum Fully Insured plan who suffers from addiction and wants to escape the influence of her regular surroundings of friends, enablers, and even suppliers, to seek treatment in another service area, will now, under this change in coverage, be denied this opportunity and forced to stay local for treatment. In fact, this change in policy seems directly in conflict with a 2019 court decision in Wit, et al. v. United Behavioral Health, which found that United Behavioral Health had violated the terms of employer-sponsored benefit plans by unlawfully dictating medical necessity determinations to deny coverage for mental health care, “to protect its bottom line.” (The ruling in Wit is currently on appeal with the Ninth Circuit Court of Appeals.)

With the Notice just recently being given and the July 1st just days away, this policy seems sudden, drastic, and not fully formulated. As explained in the next section, with very little information provided by Optum thus far, this change appears to present more questions than answers. Confusion begets chaos and for many patients who are simply seeking health care services, this chaos will almost certainly have negative impacts on their health.

Questions that Remain Unanswered

The unexpected nature of the Notice, and the extremely short lead-time before the July 1 effective date, coupled with the brevity of the Notice itself, leave far more questions than answers. We have heard numerous reports from providers and other stakeholders that Optum’s own representatives seem either unwilling or (more likely) unable to offer any specifics as to the origins and rationale behind the Notice, or how and when the changes will be carried out. Foremost among our own questions are the following:

  • What is a Service Area?Generally speaking, “service area” is a defined term in the benefit plan. However, it is not clear that plans define this term uniformly. We have heard conflicting reports about how Optum defines a service area. Some reports indicate that service areas can be very localized. For instance, a member from the San Fernando Valley area of Los Angeles was advised that a doctor from West Los Angeles would not be covered. This suggests that a member would be denied OON benefits for going less than twenty miles from home. In other instances, however, we have heard that Optum is defining a service area as an entire state. But even with this broader definition, the coverage change would still mean that individuals from other states could not travel beyond state lines for services. This is a major concern for patients seeking services at Residential Treatment Facilities because often there are not sufficient resources in the patient’s community, and in any case patients suffering from addiction frequently benefit from treatment far from their home environment, in order to escape certain “triggers” to using.
  • What happens to patients who are currently in treatment?The notice advises INN providers to prepare for the deluge of members forced to leave OON facilities outside the members’ service areas, stating: “You may be asked to accept admission of a member who is currently at an OON facility.” This seems contrary to the standard of care and normal course of business in the insurance industry. If a patient is already admitted to a facility, it could be counterproductive to their recovery to move them to a different facility on short notice. This will undoubtedly create unnecessary harm to the course of treatment that a patient is undergoing. For instance, if a patient is currently on day 14 of a treatment plan with a therapist at a facility in California, should that patient now be forced into a new facility in Iowa to be treated by a new therapist and clinical team? And will Optum’s network of INN providers even be able to handle the sudden influx of patients seeking transfer from OON facilities? This seems completely contrary to the standard of care and yet, we are concerned that is what this Notice suggests will happen.
  • How will OON providers be notified and what should they do?The notice does not appear to address OON providers. It remains unclear whether Optum has notified its members or these OON facilities that OON patients will lose coverage in the coming days. If not, how does Optum expect its members to realize that the services they are currently receiving will be no longer covered starting July 1st? If the patients must be transferred, who will coordinate and pay for these transfers? Are OON providers supposed to just immediately cease any and all discussions with potential patients who are located out of state? Will OON providers be paid for services already rendered to patients who traveled outside their service area? The questions and implications are legion, and OON providers who accept patients from other jurisdictions are understandably upset and confused about what this Notice means for their patients and their business.

Next Steps

If you are an OON network provider with Fully Insured patients, we recommend that you:

  • Contact Optum as soon as possible to find out if patients currently in treatment will lose coverage;
  • Ask Optum if there is a way to appeal the decision on a patient-by-patient basis;
  • To avoid non-payment, clarify with Optum before admitting any new “Fully Insured” patients; and
  • Notify patients about the potential for having to pay out-of-pocket or be transferred.

In the meantime, Nelson Hardiman is continuing to track this issue and explore options for providers to mount a legal challenge against it. We are concerned that Optum’s new policy is a violation of Mental Health Parity laws. While on its face the Notice appears to apply to both medical and behavioral care, in practice there likely will be a disproportionate impact against behavioral health providers, especially residential treatment facilities. As mentioned above, patients in need of residential services often have trouble finding available facilities in their community and, even when they do, there is some evidence that treatment is more effective when patients are able to get away from the problematic influences of their regular environments. Thus, taking away the ability to travel to OON providers outside the service area may, as a practical matter, significantly limit the availability of effective residential treatment services. Not only does this strike us as being a parity violation, we are concerned that insureds are being deprived of a legally-guaranteed essential health benefit and are having their consumer rights violated by this reduction in benefits (while they continue to pay the same, or higher, premiums).

We invite you to contact us with any additional information you have obtained regarding this important matter.  Please stay tuned for further developments.

Authored By:

Daniel Eliav  E:Deliav@nelsonhardiman.com

Zachary Rothenberg  E:[email protected]

John A. Mills E:[email protected]

VIEW CLIENT ALERT

*This article is provided for educational purposes only and is not offered as, and should not be relied on as, legal advice. Any individual or entity reading this information should consult an attorney for their particular situation.


Can Britney Spears Really Terminate Her Conservatorship? Experts Weigh In After Bombshell Hearing

Nelson Hardiman LLP’s Managing Partner Harry Nelson was asked to weigh in on the latest hearing regarding Britney Spears conservatorship by People Magazine.

Full Article Below:

Following Britney Spears’ impassioned plea to a Los Angeles court to terminate her conservatorship, many are wondering what happens next. During the hearing, Spears was not questioned by her conservators’ lawyers, nor have they had the opportunity to rebut her allegations in court. As stated by the judge on Wednesday, Spears still needs to file a formal motion to end the conservatorship.
PEOPLE spoke to three legal experts who are not involved in Spears’ case – healthcare lawyer Harry Nelson, family law attorney and former psychologist David Glass and trust and family law attorney David A. Esquibias (who represents Amanda Bynes) – to break down what might happen next.
How common is it that someone as young as Britney Spears is under a conservatorship?

David Glass: What makes this unique is that Britney is a young person who has apparently suffered from mental health problems. It makes sense for older people who can’t remember where they live, can no longer drive and are having trouble knowing what’s going on in their day-to-day life, for them to have someone step in and start making decisions for them. Those people also typically won’t come and complain to the court and say, ‘This is unfair, I’m being controlled, I want some freedom, I don’t want these people lording over me,’ because they don’t know that that’s going on. They’re dealing with dementia.

David Esquibias: Usually someone in their 30s who is conserved is developmentally disabled. They have to be substantially unable to manage their financial affairs and resist fraud and undue influence from others. There has to be no other alternative. The conservatorship has to be the last resort.
RELATED: Britney Spears Was ‘Very Nervous’ to Speak in Court but ‘Wants Big Changes’: Source
Is it uncommon for a conservatee to speak in court?

Esquibias: Typically, a conservatee is invited at the very least to the first hearing, which is generally required by law unless waived by the conservatee’s lawyer or doctor. And then a conservatee is invited to attend any other hearing, but their presence is not mandatory. They can speak any time, and I would think any judge would be willing to listen to a conservatee because the conservatorship is a very important process. It deprives the conservatee of their rights, takes those rights and gives them to somebody else.

How common is court-mandated birth control and psychiatric medication for people under conservatorships?

Harry Nelson: It’s fairly unusual. You tend to see it in cases where you’re dealing with adults with a significant cognitive deficit or with some kind of severe mental health issue where they are at potential risk of self-harm or harm to others. So it’s pretty rare and pretty narrow set of conditions. My view is that it’s absolutely shocking that this is still in place for somebody like Britney Spears.
Esquibias: Typically, a conservator doesn’t have the right to force psychotropic drugs or secured perimeter facilities – facilities with locked doors where they can’t walk in or out. It requires special sign-off from the judge, and is sometimes used for dementia patients or in some cases people with severe mental illness. As invasive as it sounds, a conservatee can be told you have to be on birth control. The idea is to protect the conservatee because the conservatee is unable to care for herself while pregnant or during childbirth.

Britney said multiple times she wants the conservatorship to end without an external evaluation. Can that happen? What next steps can she take and how long would the process take?

Esquibias: A judge is obligated to take in all the evidence, and in a conservatorship setting the evidence typically includes the confidential written report of the probate investigator who is usually a licensed social worker who interviews the conservatee and all family members to the second degree. Based on those interviews, the investigator comes to a conclusion and writes a recommendation to the judge. The judge takes in that piece of evidence and listens to the testimony of the conservator, the conservatee and to any relative to the second degree, and frankly, anyone else the judge wants to listen to. After taking in all the evidence, the judge is equipped to make a decision. That’s why it would be very unlikely to render a decision without the opinion of a medical expert.

Nelson: The judge has the discretion to say they want the evaluation. In a normal situation, that would be an appropriate step to take. I just think this case is a black eye on the conservatorship system in California, and the fact that Britney has been subjected to this is scary. You think about somebody that has her fame and power in public, and she’s been subjected to this. I think it undermines the credibility of our system. It’s almost a monstrous kind of circumstance that this has been allowed to stand.
A judge is going to have to decide whether they’re going to want an independent review or evaluation. I would think if she is able to demonstrate – even though it is common to rely on outside sources, judges generally don’t like to be in the position of making direct evaluations and are often deferring to outside evaluators – I think there is enough evidence here for a judge to forego that evaluation. The judge may want another evaluation, but I would not be surprised if the judge forego it altogether based on the evidence that she is not somebody that needs to be under these severe controls.

Glass: She said she’s done her research and she’s found out that conservatorships are sometimes terminated without an evaluation and that’s not exactly true. In order for the court to terminate a conservatorship, they need to make a finding that the person has regained their capacity. They lost the capacity to make decisions for themselves regarding their health, regarding their estate, their money. And now the court has to make the decision that the person has regained their capacity. The only way to do that really is to have a doctor or psychologist or even a neuropsychologist do a full analysis. Have her into the office, do a full neuropsychological battery [of tests] to show that she can make decisions, she does understand the difference between right and wrong, she understands the importance of money, all those sorts of things have to be decided, so it’s very unlikely that the court is going to let her out of this conservatorship without those underlying findings. 

How long is all of this going to take? What are the next steps?

Glass: The court said that it will work with all parties and their counsel to find the next available dates. Sometimes when you’re in court you can file something and it won’t get heard for six months, but I don’t think the court is going to do that here. The court seemed inclined to move this along as quickly as possible.

Britney is going to have to meet with her court-appointed attorney, Sam Ingham, and he’s going to have to file two different pleadings: one is a petition for termination of the conservatorship where she explains why she got into it, what kind of treatment she’s received, how she’s different now than she was 13 years ago and why she now thinks she has the capacity to care for her own person and to care for her estate. The other thing she’s going to have to work with Mr. Ingham on is she made a request that she doesn’t want to work with Ingham anymore, he was appointed by the court – again, people who are under a conservatorship can’t make their own decisions, they can’t go out and hire an attorney or pay an attorney because they don’t have the capacity to make these decisions, so the court always appoints someone. Sam Ingham is well-regarded in Los Angeles in the probate court world. He’s one of the top people. Looking over the pleadings on the docket, he’s been very careful for her but she’s asking to replace him with private counsel and he’s reported to the court, “If Ms. Spears asks me to do this, I will do it.”

Press Inquiries Contact: [email protected]

 

About Nelson Hardiman

Nelson Hardiman LLP is the premier healthcare and life sciences firm in Los Angeles, serving healthcare providers, investors, and organizations that need a hard-to-find level of quality advice on the most sensitive industry issues. The firm’s litigation practice specializes in defending fraud and abuse and whistleblower actions, government investigations, reimbursement disputes, and other complex business disputes. Nelson Hardiman regularly serves as outside counsel for healthcare system clients and medical staff representation. Nelson Hardiman’s transactional group handles healthcare organization acquisitions, sales, investment, and financings, and Nelson Hardiman’s regulatory team advises on compliance with licensing, operational, and reimbursement issues across the full continuum of healthcare industry sectors, with expertise on Medicare and Medicaid requirements, privacy and data security, FDA, and many more matters. The firm has earned a singular position reputation nationally for its leadership in addressing issues in behavioral health. More information about the firm is available at www.nelsonhardiman.com or at 310.203.2800.