Managed care continues to have a tremendous impact on health care. Our Health Care Practice Group has provided a full range of services related to managed care arrangements including all aspects of HMO and PPO development, acquisition and sale, managed care joint ventures, independent practice associations (IPAs) and physician-hospital organizations (PHOs). Our qualified’s services include determination of appropriate structures and business forms, contracts with providers and payors; contracts with Medicare and federal employees; fraud and abuse, and reimbursement issues; insurance regulatory compliance and Department of Insurance matters; and securities exemptions, offerings and registration matters.
The relationship between hospitals and physicians is important to both providers. Our qualified Health Care attorneys have worked with hospitals to draft medical staff bylaws and have counseled hospitals as well as individual health professionals on various questions involving medical staff activities and hospital bylaws. This work includes counseling on malpractice insurance issues; peer review activities; immunity and National Practitioner Data Bank issues (including the operation and effect of the Health Care Quality Improvement Act); disciplinary activities (including summary and automatic suspension hearings); revocation of clinical or admitting privileges; medical staff membership issues (including questions involving closed medical staffs); and the role of allied health professionals.
Medicare/Medicaid Reimbursement and Appeals
We have counseled health care clients on a wide range of issues related to the Medicare and Medicaid payment pro-grams, including extensive work on ways of lawfully maximizing reimbursement in various situations (such as joint ventures and corporate restructurings); and administrative reviews and judicial appeals. Benveniste law offices has dealt with certification, conditions of participation, coverage, reassignment and other government reimbursement issues for all types of government certified providers.