Buchalter’s Health Care attorneys provide timely, expert and business-oriented counsel to clients in every aspect of the health care industry, including health systems, hospitals, independent practice associations, medical groups, physicians, provider trade organizations, health care lenders, pharmacies and drug and device companies. Whether you need a lawyer to defend a lawsuit, shepherd a transaction over the finish line, or provide expert strategic guidance on a complex governance issue or a complex contract, Buchalter attorneys are the counsel of choice for the health care industry.
We have significant expertise in counseling virtually every kind of health care industry stakeholder: for-profit and nonprofit hospitals, academic medical centers, Federally Qualified Health Centers, ambulatory surgery centers, management services organizations, emergency room and hospitalist staffing companies, physician groups, telemedicine providers and other internet-based health care companies, medspas and nonprofit research organizations. Our lawyers have deep expertise in all aspects of our clients’ business lifecycle, from formation and funding through the myriad of regulatory and operational issues to sale or dissolution.
As business lawyers, we are highly skilled in transactions involving health care clients (including navigating the obstacle courses of federal and state regulation) and routinely handle mergers and acquisitions, joint ventures, syndications, disaffiliations and contractual relationships of all kinds. We are thoroughly versed in the regulatory aspects of our clients’ businesses, and commonly provide advice regarding the federal Stark, Anti-Kickback and False Claims Act statutes (and their state-law analogues), HIPAA, EMTALA, license and staff privilege issues, tax-exemption issues, telemedicine issues, and corporate practice of medicine issues.
With respect to legislative and regulatory issues, our attorneys are well-versed in health care reform legislation and regulations and can guide clients through the formation and implementation of integrated delivery systems and accountable care organizations. We have significant expertise in the specialized area of financially distressed health care businesses, and we represent purchasers, lenders, ombudsmen, creditors’ committees, debtors and many others in bankruptcy and workout situations.
As litigators, we are effective, aggressive and practical advocates for our clients’ interests in disputed situations. We have represented both plaintiffs and defendants in arbitrations, mediations, settlement negotiations and trials in state and Federal forums throughout the country, involving shareholder and other corporate disputes, reimbursement lawsuits against major health plans, and multiparty, bet-the-company litigation on a variety of other issues affecting our health care clients.
Regardless of the specific situation, Buchalter health care lawyers work collaboratively with their colleagues throughout the firm, drawing upon their specialized expertise as the situation requires. On behalf of our health care clients we have access to expert corporate, tax, labor and employment, intellectual property, real estate, commercial finance, insolvency, corporate governance and executive compensation advice, ensuring that our client representation is complete and seamless, communication is rapid, strategy is guided by hands-on experience and the attorneys involved work as an efficient, close-knit team.
Representative Matters
Corporate: Mergers & Acquisitions/Transactions
- Advised large medical groups on multi-million-dollar, multi-state acquisitions.
- Represented Language Access Network, LLC and its sister company Carenection, LLC in a sale of preferred equity to Kayne Partners
- Assisted a health maintenance organization with respect to tax and governance issues in a transaction involving transfer of control and creation of a community foundation.
- Assisted a health care district in acquiring the assets of a hospital and then opening a new hospital campus.
- Assisted a major children’s hospital in the renewal of a long-term relationship with a medical school, including establishing a faculty practice plan and creating a new system for recruitment of pediatric sub-specialists with academic appointments.
- Assisted numerous health care providers in analyzing, modifying and implementing changes to their organization and operational structures.
- Represented the physician sellers of a 51% ambulatory surgery center interest to a national surgery center operator
- Represent a multi-site surgery center operator in acquisitions and operational issues
- Represented a strategic buyer in the acquisition of a majority interest in a southern California multi-site anesthesia practice
- Represented sellers in the sale of a hospitalist and intensivist medicine group, to Team Health, a national, public hospital based medicine provider.
- Represented Sellers in the sale of two Southern California imaging centers to a national imaging provider.
- Represented the Selling physicians in the sale of a fifty-one percent interest in a bay area surgery center to a joint venture comprised of Dignity Health and United Surgical Partners International.
- Represented Sellers in the sale of a workers compensation-qualified medical examiner company to Examworks, a NYSE listed company.
- Represented a large emergency medical group in its sale to Team Health
- Sale of a large medical practice to a medical foundation affiliated with a nonprofit health system.
- Represented El Camino Hospital as borrower’s counsel in a $160 million bond issue by the California Health Facilities Financing Authority
- Represented health care management services organization in the establishment of a new management services organization and related corporate matters.
- Assisted with a contractual arrangement and reimbursement terms to create income stream for multi-hospital health system.
- Participated in negotiation and drafting of agreement creating an accountable care arrangement with an existing IPA to position the client for federal health care reform
Reimbursement/Managed Care Litigation
- Defeated potential dismissal of action by Prime Healthcare Services against Humana Insurance Company for alleged Medicare Advantage underpayments and won sanctions motion against Humana for misrepresenting the Medicare appeals process.
- Defeated potential dismissal of action by large hospital system against major health plan on lawsuit for reimbursement of claims regulated by the Department of Insurance, where previously there was no private right of action.
- Negotiated multi-million dollar reimbursement dispute against major health plan on behalf of national hospital system.
- Represented emergency physician group in Centinela-Freeman Emergency Medical Associates v. Health Net of California. In a unanimous published decision, the Supreme Court of California held in favor of the physicians. Finding the HMOs’ conduct demonstrated negligence and showed a degree of “callousness,” the court ruled that negligent delegation is a viable cause of action in California. This decision has had a profound impact on the health care industry as a whole.
- In this seminal case (one of the health care industry’s most significant decisions), Bell v. Blue Cross of California (2005), 131 Cal.App.4th 211, we successfully argued that health plans are responsible for reimbursing a reasonable portion of out-of-network emergency service providers’ costs.
- In Prospect Medical Group v. Northridge Emergency Medical Group, et al. (2009), 45 Cal.4th 497, one of California’s most controversial decisions, we convinced the California Supreme Court to hold that patients cannot be billed when their HMOs fail to pay, and affirmed the provider’s right to seek reasonable reimbursement.
- Represented a health care company on behalf of approximately 50,000 physicians in a $94 million nationwide claim against a major payor.
- Obtained a favorable result on behalf of a provider against a county-organized health system that systematically down-coded and underpaid thousands of claims. The case led to a string of newspaper articles and the resignation of several individuals.
Business/Commercial Litigation
- Represented a national health care consulting company in a shareholder derivative action in the Chancery Court of Delaware. After a highly contested litigation, a settlement was secured less than a week before trial that allowed the client to part ways with the shareholder, giving it the ability to freely conduct business.
- Successfully represented and secured the dismissal of an emergency medical group that was sued as a cross-defendant in a $50 million unfair competition case between a major health plan and a large hospital system. The health plan claimed that the hospital and our client defrauded the health plan, along with members of the general population, and challenged stability determinations made by the treating physicians.
- Represented a provider in an action brought by a major insurer alleging illegal kickbacks in exchange for the referral of specimens to a toxicology laboratory.
- As amicus curiae, successfully defended the government’s right to seek legal remedies against health plans for unlawful behavior. The rehearing in People v. Wellpoint (2010), 180 Cal.App.4th 138, denied 2010 Cal.App.LEXIS 86 as well as 2010 Cal. LEXIS 3215, a suit in which the California Court of Appeal upheld the City Attorney of Los Angeles’s right to sue health plans for unfair business practices.
- Represented an IPA against a major health plan in a breach of contract case dealing with a risk-sharing pool agreement.
- Represented Alaskan physician group in a long-simmering dispute with a tribal health organization.
Regulatory & Compliance
- Drafted compliance program for a health care provider and facilitated multiple E/M billing and coding audits of clients’ claims for compliance purposes.
- Developed policies and procedures for substance abuse providers relating to marketing, referrals, and payor relationships to comply with federal and state regulations.
- Provided health care corporate and regulatory advice in connection with successful defeat of TRO seeking return of 60 physical therapy clinics to sellers; prepared structure for reorganization to comply with corporate practice doctrine.
- Represented a national optical company and a vision health plan in negotiations with the California Attorney General, the Department of Managed Health Care and Governor’s legislative working group to obtain a comprehensive legal and legislative solution for the retail co-location of opticians and optometrists
- Defended the American College of Emergency Physicians, State Chapter of California, Inc., against an action brought by payor advocacy groups to change the reimbursement procedure when handling non-contracted emergency service providers.
- Advised various telehealth providers regarding the patchwork of state laws applicable to their businesses.
Fraud & Abuse
- Represented a large provider in an Office of Inspector General (OIG) coding investigation, obtaining a dismissal for the client.
- Represented owners of a hospital system in defending false claims qui tam lawsuit asserting violations of the Stark and Anti-Kickback laws obtaining a favorable settlement for client.
- Successfully represented an emergency physician group being investigated by the Office of Inspector General for coding and billing irregularities, and other health care fraud as a result of a sealed qui tam suit filed under the False Claims Act.
- Represented numerous substance abuse treatment facilities in recoupment requests and audits from major payors.
Administrative Law
- Successfully represented a psychiatrist after a national health plan improperly terminated the provider’s contract based on complaints regarding the psychiatrist’s use of an alleged controversial treatment called “transcranial magnetic stimulation therapy.”
Bankruptcy
- Represented House Clinic Foundation in an asset purchase and merger with the bankruptcy estate of House Research Institute, a world-renowned charitable organization engaged in hearing research
