Health Care

Building a healthy synergy in business and government

Brownstein Hyatt Farber Schreck's Health Care Group provides comprehensive legal, business, government relations and litigation advice to a wide range of health care related entities including national HMOs and PPOs, managed care entities, hospitals and hospital systems, provider groups, IPAs, third-party administrators, government contractors, dialysis providers, individual health care professionals, and manufacturers and distributors of pharmaceuticals, medical devices and health care technology.

Brownstein's Health Care Group represents industry leading clients who are dominant players in the national health care arena, providing daily counsel on a wide array of regulatory, compliance, licensing and contracting issues. Our attorneys are recognized as leaders in the field of health care law, and include former in-house legal counsel to national health care entities which gives them the ability to understand the impact of health care regulation on the day-to-day operations of the business, and address effective implementation strategies.

Regulatory Compliance

Our attorneys have extensive experience in all aspects of compliance and reimbursement issues for Medicare Parts A, B, C (Medicare Advantage) and D (Prescription Drug Plan), as well as commercial health plans. The firm routinely advises clients on legislative and regulatory compliance (including the Affordable Care Act), Stark, Fraud and Abuse, and audit readiness, and on working with state and federal regulators on licensing and enforcement issues.

Brownstein advises clients on ERISA, Medicaid, HIPAA privacy and data security laws. We have assisted health care clients with Medicare (CMS) audits and appeals.

Litigation

Our attorneys have extensive experience in litigating all aspects of managed care and network contracting disputes, payor/provider contracting and reimbursement litigation, benefits litigation, and ERISA preemption, Medicare and Medicare Advantage issues. The firm has significant experience in litigating ERISA and non-ERISA health care benefits litigation, including breach of fiduciary duty claims under ERISA.

The firm has unique experience in the representation of Medicare Advantage plans in a wide array of litigation matters ranging from provider reimbursement issues to network compliance, termination, overpayments and provider fraud. We have appeared in numerous hearings and before the Medicare Appeals Council.

Brownstein represents national health care entities in defense of health care related class action cases, including coverage issues and ERISA based breach of fiduciary duty and reimbursement.

Transactional

Our attorneys represent managed care entities and hospitals in the design, negotiation and implementation of all manner of health care contracts, including payor/provider, hospital/provider, administrative services, and insurance producer agreements. We also have experience implementing clinic buy and build and de novo growth strategies, structuring joint ventures with physician investors, obtaining private equity and credit facility financing to fund aggressive growth, preparing medical director agreements and medical services agreements, coordinating ongoing client needs with respect to clinics, including construction contracts, leasing, patient and vendor disputes and follow-on acquisitions, and structuring, negotiating and documenting liquidity events for our clients.

Government Investigations

We represent public and private companies in criminal and civil investigations by the Office of Inspector General (OIG), the U.S. Department of Justice, and its U.S. Attorneys Office.

Government Relations

Our comprehensive government relations representation focuses not only on the Congressional committees with direct jurisdiction over health care issues, but also on individual members of Congress whose home districts are affected by health care businesses, products and concerns. Our team of former high-level Capitol Hill and executive branch staffers brings years of experience and mature judgment to bear on behalf of our clients.

The scope of our Health Care practice includes strategic advice for moving or stopping particular legislative proposals; providing information to key members of Congress and their staffs; negotiating the scale of investigations, hearings and testimony; strategizing ways to maximize opportunities to provide positive messages; preparing witnesses for testimony; and navigating the political and legal minefields associated with any issue before Congress.

Our experience includes representing two of the world's largest pharmaceutical companies and an association of medical products manufacturers on a wide variety of legislative, oversight and regulatory issues.

Representative Matters

Regulatory Matters

  • Representation of hospitals in Stark compliant physician recruitment and contracting matters.
  • Representation of health plan in design and implementation of health care delivery system including, provider contracts, administrative agreements and licensure.
  • Representation of Medicare Advantage organizations and PDP sponsors in corrective action plan development and implementation related to marketing and enrollment sanctions.
  • Representation of Medicare Advantage organizations, PDP sponsors and commercial health plans in implementation of the legislative and regulatory requirements of the Affordable Care Act (health insurance reform).
  • Representation of Medicare Advantage organizations and PDP sponsors in operations, finance and risk adjustment data validation audits by the Centers for Medicare and Medicaid Services.
  • Representation of Medicare Advantage organizations, PDP sponsors and commercial health plans in compliance plan development and implementation, audit readiness, and legislative and regulatory compliance.
  • Representation of PDP sponsors in corrective action plan development and implementation related to Low Income Subsidy auto-assignment sanction.
  • Representation of commercial health plans in operations and finance examinations by state Departments of Insurance.
  • Representation of commercial health plan in U.S. Department of Justice anti-trust investigation of hospital system acquisition.
  • Representation of health plan in due diligence, regulatory approval, and Medicare Advantage contract novation process related to membership sale transaction.
  • Represented HMOs in legislative committee hearings on proposed HMO liability legislation.
  • Represented HMO in action against Department of Insurance in challenge to Department's denial of proposed coverage and exclusions and limitations.
  • Representation of hospitals, health plans and individual physicians in peer review and quality assurance administrative hearings and related litigation.
  • Representation of health plan in protest of State of Arizona's bid process to secure a five (5) year contract covering over 95,000 lives.

Litigation Experience

  • Obtained defense verdict in jury trial brought by Medicare beneficiary against staff model Medicare HMO for post-surgical rehabilitation treatment.
  • Obtained District Court decision for Medicare Advantage Plan to limit non-contracted, non-Medicare provider to Medicare Reimbursement rates.
  • Obtained arbitration award in favor of HMO in action brought by terminated provider network seeking multi-million dollar damages for claimed improper contract termination.
  • Obtained arbitration award for HMO in excess of $4 million for overpayments made to a national dialysis company.
  • Obtained arbitration award for HMO for $2 million in overpayments to national hospital system.
  • Obtained arbitration award in favor of HMO in action brought by terminated hospitalist group.
  • Representation of HMOs in numerous lawsuits brought as a result of failed capitated medical management companies and networks.
  • Successfully defended HMO at injunction hearing seeking to prevent termination of provider group premised upon Medicare regulations.
  • Successful representation of Medicare Advantage plan in proceedings before the Medicare Appeals Council.
  • Representation of health plan in putative class action regarding rescission of individual health policies.
  • Representation of plan administrators and corporate health plans in putative class action.
  • Representation of HMO in successful denial of attempted class certification by Medicare HMO beneficiaries.

Corporate Transactions

  • The Firm represent Firehouse Ventures, LLC, a veterinary practice roll-up organization, in general business and corporate advisory legal matters. Brownstein helped to form the company, guided the founders through several rounds of equity and debt financings, and have provided employment, ERISA and benefits advice including phantom stock plans. Brownstein also handles all of Firehouse Ventures' litigation, real estate and practice acquisitions.
  • Represented Emergency Medical Services Corporation in the financing of new senior secured credit facilities consisting of a $425 million 5-year term loan and a $150 million revolving credit facility, both of which will mature in 2015. Proceeds from the new senior credit facilities and cash on hand have been used to repay the outstanding balance of the Company's approximately $200 million term loan and also will be used to call its 10% senior subordinated notes, with an outstanding balance of $250 million.
  • Lead counsel for Renal Ventures Management, which owns and/or operates 20 kidney dialysis clinics, predominately in New Jersey and Texas, with an aggressive acquisition strategy and strong potential for growth. General corporate representation in ongoing company matters, formation of new dialysis joint ventures, and acquisition of existing dialysis clinics, as well as support potential policy work regarding Medicare review and certification process with respect to new clinics. Structure joint ventures to provide physicians with ownership while complying with Stark law requirements and prohibitions on physician self-referral. Prepare medical director agreements, medical services agreements, and physician noncompete documentation. Coordinate all ongoing client needs with respect to clinics, from construction contracts to leasing to patient and vendor litigation.
  • Counsel to Aion Partners LLC, a Colorado-based sales organization dedicated to saving lives and lowering costs in the United States health care system by reducing infections acquired in hospitals through a comprehensive decontamination of the physical plant using a proprietary Chlorine Dioxide based cleaning solution known as Electro-Biocide. Assisted Aion in securing the intellectual property rights to sell this proprietary, environmentally green technology that targets one of the greatest challenges in health care today: the need to minimize the occurrence of hospital acquired secondary infections. Assisted Aion in its corporate structuring and in its private placement to raise sufficient equity to bring its technology to market.
  • Represented Epimmune Inc. in connection with its business combination with IDM S.A. and listing on the NASDAQ National Market. Epimmune Inc., based in San Diego, is focused on the development of vaccines using multiple epitopes to specifically activate the body's immune system.
  • Represented Critical Homecare Solutions, Inc. in its acquisition of 100 percent of the capital stock of Infusion Solutions, Inc., a private company owned by three individuals involved in the day-to-day operations of the company. The acquisition was funded by a draw on Critical Homecare Solutions' revolving credit facility with Jefferies Finance, LLC. Brownstein drafted all transaction documents including employment agreements with Infusion Solutions' principals.
  • Represented Infusion Partners, Inc. in its acquisition involving 100 percent of capital stock of Scott Wilson, Inc., a private company owned by two principals involved in the day-to-day operations of the company. The acquisition was funded by an equity investment by Kohlberg & Company, the principal shareholder of Critical Homecare Solutions, in the form of Series A Preferred Stock. Brownstein drafted all transaction documents including the employment agreements for Scott Wilson's principals and equity investment documents.
  • Represented Critical Homecare Solutions, Inc. in its acquisition involving 100 percent of the capital stock of Wilcox Medical, a private company owned by two principals who received employment agreements. The acquisition was funded by an equity investment by Kohlberg & Company, CHS' principal shareholder, in the form of Series A Preferred Stock. Brownstein drafted all transaction documents including the equity investment documents.
  • Represented Madison Capital in making a mezzanine loan to a public hospital in Washington State that was being sold and then converted to a private hospital. The loan was highly negotiated, and repayment was dependant upon completion of the sale of the hospital which necessitated lenders counsel to be apprised of the licensing issues inherent in going private, among a general understanding of the hospital and its revenue as the main source for the repayment of the mezzanine debt.
  • Counseled lead partner MGL Partners on joint venture structuring and equity financing for Residences at Boulder Creek LLC, which will develop, own and operate a $50 million senior living facility in Boulder, Colorado. MGL Partners and Legacy Partners entered into the venture effective as of May 25, 2007 along with the nation’s top senior living facility manager, Leisure Care, LLC. Venture to acquire a nine-story, independent/assisted senior living community with an attached one-story skilled nursing wing, currently owned and operated by the Evangelical Lutheran Good Samaritan Society and located in Boulder, Colorado, which the Company plans to renovate and reposition the nine-story tower (currently 80 units) as 54 independent/assisted living senior housing units and to construct adjacent thereto 63 new independent/assisted living senior housing units in a new three or four story structure over parking on the grounds currently occupied by the one-story skilled nursing wing.
  • Represented Firehouse Ventures, LLC and its affiliates in the sale of all stock to VCA Animal Hospitals, Inc., a subsidiary of VCA Antech, Inc. (NASDAQ: WOOF). Firehouse Ventures owned and operated six veterinary hospitals in the Denver metropolitan area.

Government Relations

  • Represented a local private foundation in forming a public-private joint venture with a leading medical institution and a leading educational institution with seed and support funding provided by the foundation. The venture was approved by the Colorado Commission on Higher Education and represented the first time such a not-for-profit limited liability company was formed in Colorado.
  • Brownstein worked with Congress to help secure the purchase of fast-clotting combat gauze on behalf of a company who manufactures the life-saving product. The funding, which was included in FY2010 Defense Appropriations Act, will allow the U.S. Marines to utilize this unique and vital battlefield tool.
  • On behalf of an institute of higher education, Brownstein assisted in successfully advocating for federal funds for the university in the FY2010 Consolidated Appropriations Act. The university will use the funds for a training program for physicians in rural areas.
  • Successfully worked with the tobacco industry to equalize federal excise tax rates across similar products. This provision helped finance the State Children's Health Insurance Program (SCHIP).
  • Brownstein worked with a national research university and a non-profit organization to advocate for medical research equipment. A significant amount was appropriated in the FY2010 Consolidated Appropriations Act for this project.

Case Studies

Representative Matters

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