We are tactical problem-solvers in an era of healthcare reform driven by cost reduction initiatives and heightened review of utilization and medical necessity. Nelson Hardiman lawyers help managed care providers navigate the industry’s most complex business and regulatory concerns. Our experienced team understands the nuances of managed care delivery models and has a successful history advising managed care businesses.
Our clients depend on Nelson Hardiman’s deep experience in healthcare licensing, operations, and reimbursement, combined with our expertise in the compliance requirements for managed care entities under the Knox-Keene Act and the Employee Retirement Income Security Act (ERISA). We address Medicare and HIPAA compliance issues and investigations, help create integrated delivery systems, negotiate contracts and develop payment structures. From strategic issues to solution-focused engagements, Nelson Hardiman resolves the legal challenges of managed care entities.
Physicians challenged by the changing reimbursement and regulatory landscape rely on Nelson Hardiman to navigate complex health care plan options that form the basis of Independent Physician Associations (IPAs). We negotiate health care plan agreements that deliver seamless solutions for IPA members beset by administrative burdens.
Our healthcare attorneys blend their next-level healthcare management skillset with expertise on payor compliance issues to advise IPA physicians on effective health care plan options. We work with you to identify plans and processes that work with your business structure – be it a nonprofit entity, a limited liability company, a corporation or other type of shareholder-owned entity. Our experience includes structures that allow members to care for patients outside of contracted health care plans. Bottom line, Nelson Hardiman delivers the power of strength in numbers to our IPA clients, ultimately providing a platform for IPA physician members to preserve capital and share risk, maintain independent practices, and participate in coordinated care to improve patient outcomes.
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Nelson Hardiman has decades of on-point experience with managed care entities. Envisioned as a transformative for-profit model driven by the insurance industry, we cut our teeth on Health Care Maintenance Organizations (HMOs), the first form of managed care. Today we use our business acumen and first-hand knowledge of healthcare systems to provide strategic and practical guidance on operational, regulatory, transactional, and litigation matters for limited Knox-Keene and HMO entities.
Nelson Hardiman’s healthcare attorneys have navigated every conceivable legal issue for the managed care entities that provide healthcare to 90 percent of insured Americans. We address the key managed care issues impacting providers throughout the U.S., representing limited Knox-Keene licensees and health maintenance organizations (HMO’s), including Medicare Part C plans. What sets us apart is our focus on healthcare innovation and next generation healthcare and our track record of leadership in the healthcare industry.
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Our leadership position in the healthcare industry makes us adept at understanding the unique business needs of Management Services Organizations (MSOs). Because we know every aspect of healthcare law, we frequently sit at the same table with MSOs and providers. We are masters at the complex issues that arise around practice management related non-medical business functions. We hammer out MSO legal agreements around the corporate practice of medicine doctrine and help MSOs navigate the fraud and abuse arena, including anti-kickback, self-referral and fee-splitting regulations. MSOs rely on us for our highly-attuned sensitivity to the complex interplay between developing integrated practice care standards and realizing savings with third party payors, based on our shared vision of transforming the delivery of healthcare services.
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Nelson Hardiman’s undisputed knowledge of the healthcare sector and keen insights into industry trends inspires our counsel on physician-hospital ventures. Providing support for the realignment of the healthcare industry, we structure entities that benefit patients, physicians, and hospitals. We negotiate complex financial vehicles and address the full spectrum of business, regulatory and strategy concerns to build and sustain physician-hospital ventures.
Our leadership at the intersection of healthcare law and innovation drives our experience with physician-hospital joint ventures. We represent multispecialty and orthopedic ambulatory surgery centers, cardiac catheterization, cardiovascular CT imaging, vascular services, orthopedic, heart, spine, neuro-spine, and surgical specialty hospitals and many other ventures. We combine regulatory counsel on Stark and anti-kickback laws with financial acumen encompassing joint equity ventures, participating bond transactions (PBTs), and contractual integration. Nelson Hardiman aligns the goals of physicians and hospital management to create strategic growth models united by a shared vision for physician-hospital ventures.
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