Health Care Providers

The Health Care Providers section of the health care and life sciences attorneys at NM handles a broad range of health care litigations and regulatory agency administrative actions, including hearings and appeals related to allegations of professional misconduct and discipline, commercial and government insurance audits and refund requests, fraud and abuse actions, as well as disputes with agencies which oversee the practice of medicine.

Additionally, we handle regulatory compliance and transactional matters for our health care provider clients, including those related to mergers and acquisitions, joint ventures, HIPAA/HITECH, Stark and Anti-Kickback laws, and general prohibitions against the corporate practice of medicine.

The following is an overview of the specific types of matters NM has handled on behalf of our health care provider clients:

  • Represent Physicians, Physician Groups, Dentists, Psychologists, Nurses, Physician Assistants and other health care professionals before their respective licensure Boards in the states of New York, New Jersey and Pennsylvania
  • Represent medical practices and health care providers in connection with audits undertaken by Medicare, Medicaid and commercial insurers, as well as defend clients in matters involving overpayment demands resulting from allegations of inappropriate medical billing
  • Defend health care providers in instances when an institution, such as a hospital or an ambulatory surgery center, attempts to limit or revoke privileges
  • Handle appeals and disputes related to the limitation or termination of a health care providers’ participation and privileges with Medicare, Medicaid and commercial payors
  • Represent health care providers in connection with the sale, acquisition or merger of medical or dental practices
  • Advise health care providers and facilities on issues of licensure and maintenance of certification requirements
  • Defend health care providers in connection with investigations and actions undertaken by administrative agencies, including OSHA, the Office of Civil Rights (“OCR”), the Office of the Attorney General, the Department of Environmental Protection (“DEP”), the Drug Enforcement Agency (“DEA”), the Department of Health (“DOH”), and others
  • Advise health care providers on issues of state and federal privacy laws such as HIPAA/HITECH as well as data breach guidelines
  • Represent providers in drafting and negotiating employment and independent contract agreements
  • Represent physicians before specialty certification boards in matters involving suspension or termination of Board Certification
  • Litigate or arbitrate against insurance companies who fail to reimburse health care providers for services rendered
  • Defend health care providers in employment contract enforcement actions
  • Represent health care providers in fraud and abuse actions commenced by various government agencies, including United States Department of Justice, New Jersey Office of Inspector General, New Jersey Department of Banking and Insurance and New York State Attorney General’s Office
  • Defend health care providers in connection with civil “RICO” lawsuits commenced by insurance companies
  • Handle all aspects of the legal needs of health care societies as General Counsel
  • Draft and revise medical staff by-laws
  • Provide legal representation for Medical Staffs of hospitals and other institutions
  • Assist health care providers in navigating issues of impairment and resulting licensing ramifications
  • Advise health care providers on issues related to telehealth and compliance with the developing laws
  • Counsel health care providers on issues related to medical marijuana and compliance with the developing laws
  • Represent health care providers in connection with criminal actions commenced by state and federal investigative agencies

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