Long Term Care

As general counsel to many health care organizations, we provide general corporate legal services in connection with the formation, governance and operation of health care organizations, along with representation and advice to boards of directors, members and their governing authorities.

Our attorneys assist clients with the design, implementation, and maintenance of a variety of employee benefit plans, including tax-qualified retirement plans, non-qualified deferred compensation arrangements, stock-based incentive plans and cafeteria plans. Our employee benefits and executive compensation practice represents health care facilities before governmental agencies such as the Internal Revenue Service and the Department of Labor.
 

We represent numerous tax exempt, charitable health care providers and foundations, providing guidance in all areas of state and federal tax-exempt compliance. Such services include obtaining approvals and preparing documentation required by the Charities Bureau of the New York State Attorney General’s Office, obtaining tax-exempt determination letters from the Exempt Organizations unit of the Internal Revenue Service and counseling involving compliance with all applicable IRS requirements, including questions relating to Form 990 and Excess Benefit Transactions.

Fraud abuse prevention and compliance services include counseling and assistance in the development of a compliance plan for organizations along with the arrangement of training, in-service and ongoing reviews of compliance issues. We also work cooperatively with accounting firms, in-house counsel and compliance consultants, when necessary, in the assessment and review of complaints or reviews required to ensure health care compliance or prevent fraud and abuse in health care operations and billings.
 

Medicare, Medicaid, HMO, Managed Care and Private pay represent the predominant sources of funding of health care operations. We provide a full range of counseling, contract development and litigation services in these areas, with a special emphasis on third-party reimbursement litigation with respect to audits, rate appeals and retroactive adjustments/recoveries. Third Party Liability (TPL) refers to the general concept of a “third party” who may be responsible for the payment of health care services (i.e. someone other than the provider and patient). We have developed years of experience in identifying TPL so that the proper source of payment ultimately pays for health care.
 

Health care organizations have been ever expanding their scope of services, to include independent housing, adult care facilities and assistive living. We provide counseling and support services in connection with the development, financing, construction and operation within these fields.
 

As general or special counsel to health care organizations, we provide counseling regarding general employment-related issues. Employment-related matters may include review and counseling regarding individual employee complaints, terminations and matters pertaining to the workplace such as sexual harassment, discrimination, wage and hour requirements and concerns arising under the auspices of the Occupational Health and Safety Administration (OSHA). We do provide representation with regard to collective bargaining agreements as a general matter.
 

New York requires that health care be furnished by duly licensed, certified or approved organizations. The “Certificate of Need” or “CON” process generally refers to those laws that require that entities to submit establishment or licensure applications in order to engage in certain health care activities or expand into new areas of service. We provide legal assistance in all aspects of CON and licensure counseling, including assistance in the drafting and submission of all legal documentation regarding such applications as well as the provision of advice and recommendations as to operational requirements for each type of provider service.
 

Commercial Litigation

We represent public and private entities, nonprofit and for-profit corporations, who become involved in myriad business activities. Commercial litigation includes cases involving contract disputes, payment issues and issues involving real and personal property, among other matters. Our clients include health care institutions, assisted living facilities, long-term health care organizations. Our representation also involves a wide array of affirmative claims seeking to enforce the rights of our clients.

Payment Dispute Litigation

The field of health care services, in particular, is heavily regulated and complex. With regard to health care clients, counseling includes advice and preparation of forms such as admission agreements, private pay agreements and net available monthly income (NAMI) or surplus agreements with regard to long-term care providers. We will pursue all available avenues to assist our clients in this area, including guardianships, claims under the Fraudulent Conveyance Act and prosecuting health benefit appeals or TPL recoveries.

Guardianship and Estate Matters

Guardianship proceedings are often required where an individual has not designated a health care proxy or provided for a power of attorney. We have developed extensive experience in representing institutional and non-institutional clients in petitioning for guardianship in cases involving a lack of responsible representatives. We also represent clients in estate matters where claims must be filed for recovery of amounts owed by deceased individuals or where health care providers are designated as beneficiaries under a will or trust.

Health care organizations are increasingly involved in mergers, acquisitions and reorganizations. We provide a full range of regulatory and corporate guidance and transactional services in this regard. In addition, we have represented numerous health care organizations in complex financing transactions, including tax-exempt and taxable borrowings as well as credit enhancement transactions involving letters of credit and Federal Housing Administration (FHA) mortgage insurance.

Institutional and noninstitutional providers are subject to ever increasing oversight of their operations. New statutory and regulatory mandates are added on a regular basis. Long-term care providers are subject to mandated surveys and investigations of resident abuse, mistreatment or neglect, which can lead to the loss of Medicare and Medicaid reimbursement along with potential closure and civil monetary penalties. We provide thorough counseling in these areas, including assistance in Health Insurance Portability and Accountability Act (HIPAA) compliance, review of policies and procedures regarding new mandates, assistance in drafting plans of correction, submitting matters for informal dispute resolution and representation in administrative hearings and litigation involving survey enforcement.

Unlike many other industries, health care operations demand special provisions and requirements for most vendor contracts, affiliations or outside relationships. Our attorneys have extensive experience in all such contracting relationships. These may include ancillary services such as laboratory, radiology or dialysis to affiliation agreements, construction contracting and third-party payor relationships with Medicare Advantage Plans or private indemnity insurers.