Health Care

Health care professionals and institutional providers operate in rapidly changing business and regulatory environments. These providers face evolving Medicare, certificate of need and antitrust laws, while dealing with the business risks inherent in exclusive contracting, developing or acquiring technology and facilities, establishing a practice and managed care contracting. As the pressure builds on health care providers to reduce costs, business disputes and administrative oversight can lead to complex litigation.

Primary Services:

• Exclusive contracting
  
• Certificate of Need
  
• Medicare and Medicaid compliance, including anti-kickback and Stark
  
• Medicare and Medicaid fraud and abuse defense
  
• HIPAA and other federal and state confidentiality and privacy laws
  
• Managed care contracting, regulation and dispute resolution
  
• Business and contract dispute resolution and litigation
  
• Resolution of regulatory issues and administrative litigation
• Antitrust
• Electronic Health Record Implementation and Related Services
  
• Provider organizations
  
• Health care mergers and acquisitions, including practice buy-ins and buy-outs
  
• Practice and business entity formation
  
• Medical staff issues
  
• Employment issues, including covenants not to compete
  
• Professional association representation
  
• Representation before licensing boards

Additional Services:
Our firm provides specific experience in other areas such as medical malpractice defense, tax, securities law and commercial real estate.

Our Clients:
Our clients include physician practices, including hospital-based physician practices, health care professional associations, ambulatory surgical centers, hospital medical staffs, physician-hospital organizations, oncology treatment centers, and hospitals.

Our Lawyers:
Each of our lawyers is well versed in business and regulatory issues in the health care arena. Our practice also includes lawyers knowledgeable in other legal areas of interest to our clients including antitrust, managed care regulation, fraud and abuse. Our lawyers participate as invited speakers at statewide and national programs, and have authored treatises and articles on a variety of health care subjects.

Exclusive Contracts for Hospital-Based Physicians [top]
Smith Anderson lawyers have many years of experience in counseling hospital-based physicians (anesthesiologists, radiologists, emergency physicians, and pathologists, among others) regarding the unique business and legal issues associated with hospital exclusive contracting. Our lawyers regularly assist hospital-based physicians in negotiating and maintaining hospital exclusive contracts, including issues related to antitrust compliance, managed care contracting, termination of medical staff privileges, and hospital stipends. For more information, please contact: Bo Bobbitt or Dana Simpson

Certificate of Need [top]
Smith Anderson lawyers regularly advise physician practices and healthcare facilities on the application of the North Carolina Certificate of Need laws and represent our clients in Certificate of Need litigation. We think creatively with our clients about whether a Certificate of Need may be necessary for a project, whether the state has identified a need for a service or facility in a particular geographic area, and how best to meet our clients' goals in light of the Certificate of Need laws. We have assisted our clients in the submission of Certificate of Need applications, and we routinely prepare documentation confirming exemptions from review and requesting “no review” letters on behalf of our clients. In litigation, we have represented clients in cases involving a wide range of Certificate of Need issues. For more information, please contact: Sean Timmons

Medicare and Medicaid Compliance, including Anti-Kickback and Stark [top]
Smith Anderson has advised a wide variety of clients regarding Medicare and Medicaid compliance. We regularly assist in tackling discrete issues related to Medicare and Medicaid billing. We also have assisted our clients in the development of comprehensive Medicare and Medicaid compliance plans. We regularly combine our transactional expertise with our in-depth knowledge of the federal Stark and anti-kickback laws and regulations and the North Carolina anti-referral laws and regulations to assist our clients in structuring deals in compliance with these laws. We assist our clients in developing compensation plans under the “group practice” definition of the Stark law, and help our clients work within the safe harbors under the anti-kickback statute. For more information, please contact: Sean Timmons

Medicare and Medicaid Fraud and Abuse Defense [top]
We defend healthcare clients in all types of criminal and civil health care fraud cases and investigations brought by federal and state agencies, including the Department of Justice, the Office of Inspector General, Centers for Medicare and Medicaid Services, state Attorney General offices, and state Medicaid Fraud Control Units. In addition, we represent clients in dealing with audits by Medicare carriers. We zealously represent our clients by combining our regulatory knowledge with our investigative and litigation expertise. For more information, please contact: Sean Timmons or Mike Gordon

HIPAA and other Federal and State Confidentiality and Privacy Laws [top]
Smith Anderson has a team of experienced lawyers to assist our clients with HIPAA implementation and compliance under the HIPAA Privacy Rule, Security Rule, and Transactions Rule. For more information, please contact: Alicia A. Gilleskie

Managed Care Issues [top]
Smith Anderson regularly represents physician practices and other health care providers in negotiating contracts with managed care organizations (MCO), preferred provider organizations, and state employee health plans. We assist clients in securing MCO compliance with various insurance laws and regulations, including those related to: prompt payment, reimbursement of non-contracted providers, reimbursement disclosure, uniform credentialing, utilization review, assignment of benefits and payment for emergency services. We routinely advocate on behalf of clients before state departments of insurance and with state employee health plans. With the cooperation of our litigation team, we have successfully represented clients in litigation against MCOs related to improper reimbursement and unfair and deceptive trade practices. For more information, please contact: Bo Bobbitt or Dana Simpson

Smith Anderson lawyers have represented healthcare clients for over 50 years and have business dispute resolution experience at every phase, from counseling, to mediation, to litigation. Smith Anderson healthcare lawyers advise healthcare professionals and institutional providers on a wide variety of complex legal issues including business and contract disputes and healthcare regulatory issues, helping our clients understand their rights and explore cost-effective dispute resolution options.

We have represented healthcare professionals in state and federal court and before state and federal administrative agencies in cases addressing a wide variety of healthcare related issues, including dissolution of practice groups, reimbursement to providers by insurers, licensing and credentialing issues, interpretation and enforcement of group management contracts, certificates of need, issues related to managed care, covenants not to compete, peer review, contracts with software providers and other vendors, healthcare fraud cases, Medicare audits, civil and criminal antritrust matters and issues related to the interpretation of the Medical Practice Act. For more information, please contact: Bo Bobbitt or Susan Hargrove

Antitrust [top]
Healthcare is undergoing profound change. In response to this change, many healthcare providers have undertaken new ventures, consolidations, and affiliations between and among providers and payors that can present significant antirust compliance issues. Smith Anderson lawyers have decades of healthcare antitrust experience, ranging from advice in connection with the formation and operation of complex integrated ventures, such as independent provider organizations, physician and physician-hospital organizations, and management services organizations, to representation of clients in civil and criminal antritrust investigations and litigation, including matters involving the Federal Trade Commission and the Department of Justice. For more information, please contact: Robin Vinson or Bo Bobbitt

Electronic Health Record Implementation and Related Services [top]
Certain rules and guidelines arising out of recent federal legislation entitled “The Health Information Technology for Economic and Clinical Health Act” (the “HITECH Act”) not only provide significant financial incentives for healthcare practitioners, who implement and make meaningful use of hardware, software, and related intellectual property and services that provide for the electronic creation, maintenance, access, and exchange of health information by and through electronic health records (“EHR”), but also impose financial penalties on those who do not. Smith Anderson lawyers regularly assist healthcare practitioners with reviewing and negotiating software, hardware, and services agreements directed to implementing the technologies required to transition to an EHR-based practice. For more information, please contact: T. Robert Rehm, Jr.

Provider Organizations [top]
In the current regulatory and economic climate, providers need experienced and creative legal assistance to form effective provider organizations. Smith Anderson lawyers have organized a wide variety of provider organizations, including independent provider organizations, physician-hospital organizations, management service organizations, and provider-owned HMOs. These organizations involve a variety of business plans, integration levels, target markets, medical specialties, and sizes. Determining the best organization for a particular client requires an understanding of the different issues presented by governmental payors, insurers, and direct contracts with employers. Provider organizations also involve complex antitrust, tax, corporate practice of medicine, and other issues. Our experience and statewide network of relationships allow us to provide practical advice to provider affiliations and ventures. For more information, please contact: Bo Bobbitt

Health Care Mergers and Acquisitions, including Practice Buy-Ins and Buyouts [top]
Smith Anderson healthcare lawyers regularly advise institutional health care providers, diagnostic facilities, individual physicians and physician practices in the area of mergers and acquisitions, including practice buy-ins and buyouts. Smith Anderson healthcare lawyers have a wealth of experience in negotiating and drafting transaction documents, and counseling their clients through mergers, divestitures, stock and asset purchases. Smith Anderson healthcare lawyers have varied backgrounds enabling us to give our clients a full range of services in this area, including healthcare regulatory advice, business law advice, and tax advice. For more information, please contact: Kim Swintosky

Practice and Business Entity Formation [top]
Smith Anderson lawyers have a wealth of experience in the formation of practices involving physicians, dentists, and other healthcare providers. Our understanding of the healthcare business environment complements our extensive background in the corporate, tax and securities issues that can affect newly formed practices. In addition, our experience with healthcare practitioner employment agreements, practitioner buy-ins and buyouts, and managed care contracting allows us to assist our start-up practice clients with the full range of their legal needs. For more information, please contact: Sean Timmons or Kim Swintosky

Medical Staff Issues [top]
Smith Anderson lawyers have significant experience representing and advising medical staffs, physicians, provider organizations, and national and state professional associations (as amicus curiae ) on medical staff issues. We regularly advise our medical staff clients regarding credentialing and peer review issues. We also assist in the development and review of medical staff bylaws, including the associated due process, on-call and medical staff governance issues. We also have extensive experience representing physicians in medical staff disciplinary actions. Because of this experience, our lawyers understand the legal and policy implications of medical staff operations, enabling us to represent clients on these issues effectively and comprehensively. For more information, please contact: Bo Bobbitt or Jenny Markham

Physician Employment Agreements [top]
Smith Anderson lawyers regularly draft employment agreements for physician employers and review and negotiate employment contracts on behalf of physician employees. Smith Anderson healthcare lawyers have vast experience in drafting, advising, and negotiating all types of employment contracts, including dealing with the specific concerns of employment agreements between a corporation and its shareholders, physician recruitment agreements, and non-compete provisions. For more information, please contact: Kim Swintosky or Jenny Markham

Covenants Not to Compete [top]
Practitioner shortages, workforce mobility and rapid healthcare-related economic changes put increasing pressure on traditional notions of medical employment agreement non-compete provisions. Smith Anderson lawyers have significant practice experience with healthcare non-competes, and closely monitor developments in the laws governing this area, enabling us to advise our clients on contract language and represent clients involved in non-compete disputes. For more information, please contact: Bo Bobbitt or Mike Mitchell