Practices: Physician Practices

Medical groups, physician networks and other physician-driven medical practices have transformed the delivery of healthcare providers. Current issues includes the increasingly complex interaction between physician groups and hospitals, and the evolving landscape involving physician ownership of facilities, reimbursement, self-referral, credentialing and private inurement. Physicians involved in any of these arrangements need state-of-the-art guidance to maximize their practice opportunities and minimize the risk of regulatory sanctions or litigation.

Effective Guidance

From creating the proper entity structure to vigorous defense in regulatory controversies or litigation, Ungaretti & Harris healthcare lawyers provide effective guidance to physicians and hospitals regarding all physician practice arrangements. Physician practices rely on our help to craft organizational arrangements that maximize opportunities while effectively responding to federal, state and private payor healthcare initiatives. Relevant agreements – whether employment, LLC operating, general or limited liability partnership, or shareholder – will be drafted and negotiated for maximum flexibility. And your practice will have assured compliance with evolving government regulations on investment practices, compensation arrangements, reimbursement requirements, joint ventures and self-referral.

Practice Agreements

Physician practice agreements between hospitals and physicians or physician groups are highly complex business combinations. As an affiliating party you will receive our help to document all necessary operational considerations (utilization review programs, quality assurance plans, credentialing criteria), and ensure that tax, reimbursement and financing are properly addressed and integrated. Participants in these ventures benefit from our ability to ensure that you comply with all self referral and fraud and abuse regulations as well as tax laws that address the relationships between hospitals and employed or controlled physicians or physician groups.

Specialized Ventures

In almost half of the states nationwide, hospitals and physicians looking to establish ambulatory surgical treatment centers (ASTCs) must secure a certificate of need to justify the venture. If you are looking to structure an ASTC, rely on our lawyers to ensure proper documentation of all reimbursement and self-referral concerns. We help you establish the proper venture structure for the right balance of clinical and financial integration. Hospitals and physicians interested in joint ventures to secure access to advanced medical technology can also benefit from our experience. That includes insightful counsel on MRI and CT scanning centers and whether referral arrangements comply with the Stark Law and other anti-kickback statutes.

Regulatory Considerations

In a rapidly changing environment of federal, state and professional organization regulation, effective compliance efforts are essential to the business success of your practice arrangement. You can rely on Ungaretti & Harris lawyers for practical yet sophisticated help with:

• Structuring physician recruitment packages in order to avoid private inurement, impermissible private benefit and excess benefit transactions that can jeopardize tax-exempt status, particularly concerning joint ventures and other arrangements with for-profit organizations.
• Defending physician practices against allegations of fraud and abuse under federal and state laws regulating kickbacks and physician self-referral, as well as Medicare and Medicaid billing and reimbursement rules, including False Claims Act investigations by the HHS Office of the Inspector General and qui tam whistle-blower cases.
• Working to reduce the risk involved with Medicare/Medicaid reimbursement problems, such as allegations of filing false claims, incorrectly bundling and unbundling claims for service, and billing for “unnecessary” services.
• Advising in medical staff disputes involving disciplined medical staff members.

Flexible Approach

The evolving regulatory and business framework for physician practices requires a flexible approach to the complex business and regulatory issues involved. If your working arrangement with a hospital, practice association or other physician group is not properly constructed, the result can give you the worst of both worlds: competitive or tax disadvantages, coupled with regulatory problems. Ungaretti & Harris healthcare lawyers have structured and advised numerous physician practice groups, and can work with you to ensure a desired business outcome.