HEALTH CARE AND ADMINISTRATIVE LAW

The business of Health Care is complex and ever-changing. Today’s health care providers work in a state of perpetual flux, facing diverse regulatory, transactional, and litigation challenges. Knowing the law is simply not enough. A firm understanding of the industry, including the economics at play, is vital to successful navigation of the legal challenges facing today’s health care providers. Scott Patton understands the complexities of the Health Care industry. Using our collective experience and expertise, Scott Patton’s Health Care attorneys, several of whom have served as in-house counsel for large national hospital systems, navigate the challenges that our clients face, serving not simply as attorneys, but as trusted advisors and legal strategists. We believe in building loyal, long-term, client relationships that afford us the institutional knowledge necessary to provide firm clients with the guidance, vision, perspective, and solutions to help meet their professional and business objectives.

We provide comprehensive representation in all areas impacting strategic planning, development, entity formation, contracting, operations, and litigation. Our attorneys educate and advise clients on regulatory and operational challenges, including the intricacies of new health care reform legislation. Scott Patton’s Health Care Team represents health care clients in a variety of compliance matters involving state and federal health care laws, including the physician self-referral law (Stark), Anti-Kickback Statute, False Claims Act (FCA), Emergency Medical Treatment and Active Labor Act (EMTALA), Health Insurance Portability and Accountability Act (HIPAA), and others.

We routinely advise Firm clients on operational issues impacting today's health care providers including regulatory audits, disaster planning, staff credentialing, peer review, business operations, licensing, certification, risk management, delivery of care, including the patient’s right to receive and refuse treatment, physician practice guidance, and reimbursement matters. We also represent doctors, nurses, and other health care professionals in matters before state licensing boards. When a professional’s credentials are on the line, we help them negotiate the troubled waters of an investigation. In short, the Firm's Health Care team offers knowledgeable counsel that reflects a thorough understanding of the laws governing health care activities.

REPRESENTATIVE MATTERS

THE FOLLOWING LIST IS A SAMPLING OF LEGAL AND ADMINISTRATIVE WORK DONE ON BEHALF OF THE FIRM’S HEALTH CARE CLIENTS.

ACCREDITATION

  • Representation of a health care client in a Joint Commission inquiry regarding care rendered to a pediatric patient that sustained an injury following a surgical incident.

  • Representation of a health care client on accreditation standards regarding disruptive behavior including revision to medical staff rules and regulations.

  • Representation of a health care client in the preparation and response to an inquiry following media reports of adverse patient care.

  • Representation of a health care client in the investigation by investigators regarding inadvertent use of contaminated surgical instruments.

COMPLIANCE / FRAUD AND ABUSE

  • Representation of providers in an alleged "over billing" investigation by the Attorney General's office.

  • Representation of large group in an alleged "over billing" investigation by the Inspector General's office.

  • Representation of health care client to perform detailed audit and analysis of sleep lab licensing regulations pertaining to multiple location facility.

  • Representation of a health care client in the analysis of billing arrangements for compliance with in-office ancillary services exception to the physician self-referral law (Stark).

  • Representation of a health care client in the advisement and counsel on a proposed joint venture under arrangement with a rural hospital for in-hospital laboratory services.

  • Representation of a health care client in the advisement and counsel on fraud and abuse compliance issues involved with acquisition of Durable Medical Equipment (DME) enterprise intended to augment the existing health care structure.

  • Representation of a health care client on potential compliance issues involving federal anti-kickback statute, Texas anti-solicitation statute, Stark, False Claims Act, Tax Exemption, Intermediate Sanctions and Provider Based Status Rules.

  • Representation of numerous health care clients in the drafting of HIPAA compliant Business Associate agreements in multiple contexts.

  • Representation of a health care client following the theft of 1,100 pages of documents containing protected health information of 2,100 patients including the advisement and counsel on privacy rules and requirements.

  • Representation and counsel of health care client following the theft of a field staff notebook computer containing protected health information.

  • Representation of a health care client in the investigation, coordination and preparation of timely corrective action plans for the Center for Medicare and Medicaid Services (CMS) and Texas Department of State Health Services (TDSHS) for alleged Emergency Medical Treatment and Active Labor Act (EMTALA) violations regarding the treatment and transfer of patients.

  • Representation of a health care client in the investigation, coordination and presentation of a practitioner's response to a Texas Medical Foundation investigation of an alleged improper transfer of a patient suffering from an emergent medical condition.

CONSENT

  • Representation, advisement and counsel of a health care client including trial in probate court to appoint a guardian for the patient in face of refused care proceeding by family.

  • Representation of a health care client in the coordination of voluntary/involuntary commitment proceedings for mental health services for suicidal patients presenting to an Emergency Department.

  • Representation of a health care client in the preparation, development and implementation of medical futility policy.

CONTRACTS AND CONTRACTUAL REIMBURSEMENT

  • Representation of health care clients in the preparation of general service agreements (for example, laundry provider contracts, equipment purchase agreements, radiology and diagnostic imaging services).

  • Representation of health care clients in the review and negotiation of medical equipment service agreements with providers.

  • Representation of health care clients in third party reimbursement appeals and litigation.

  • Representation, advisement and counsel of a health care client in arbitration proceedings against national insurance providers regarding payments of amounts owed for services provided to enrolled beneficiaries.

CORPORATE

  • Representation of health care clients in corporate organization of entities including initial offerings, articles of incorporation, by-laws, initial meeting documents, etc.

  • Representation of health care clients in the development and modification of corporate agreements, bylaws and articles of incorporation.

LITIGATION, ARBITRATION AND DISPUTE RESOLUTION

  • Representation and defense of hospitals, physicians, nurses, chiropractors and other health care providers in complex professional liability/medical malpractice and negligence matters brought in state and federal courts.

  • Representation of health care clients in complex commercial and general litigation matters brought in state and federal courts as well as arbitration.

  • Representation of hospitals, physicians, dentists, nurses and other health care providers before state regulatory and licensing agencies.

  • Representation of health care clients in the administrative appeals process involving various state health care regulations through the State Office of Administrative Hearings (SOAH) process.

MEDICARE AND THIRD PARTY REIMBURSEMENT

  • Representation of physician groups and independent practitioners in the administrative defense of Medicare recoupment actions.

  • Representation of a health care client in the advisement, counsel and joint negotiations with a local hospital and Center for Medicare and Medicaid Services (CMS) regarding the correction of billing errors related to diagnostic imaging.

PHYSICIAN RELATIONS, CREDENTIALING AND PEER REVIEW

  • Representation of health care clients in internal peer and quality review investigations including representation in administrative proceedings, fair hearings and other related inquiries brought pursuant to facility by-laws, rules and regulations.

  • Representation, advise and counsel of health care clients regarding National Practitioners Data Bank and Texas Medical Board reporting requirements.

  • Representation, advise and counsel of a health care clients on accreditation standards regarding disruptive behavior including revision to Medical Staff Rules and Regulations.

  • Representation, advise and counsel of a health care client in the negotiation of formal practice assessment agreements with investigated practitioners to ensure high quality patient care.

  • Representation of health care clients in litigation arising from peer review based disciplinary actions.

STATE / FEDERAL SURVEYS AND INVESTIGATIONS

  • Representation of a health care client in the investigation, coordination and preparation of timely corrective action plans for the Center for Medicare and Medicaid Services (CMS) and Texas Department of State Health Services (TDSHS) for alleged Emergency Medical Treatment and Active Labor Act (EMTALA) violations.

  • Representation of a health care client in the investigation, coordination and preparation of a timely corrective action plan for the Texas Department of Aging and Disability Services (DADS) regarding alleged improper coordination of care of home health and rehabilitation services to pediatric patients.

  • Representation of a health care client in the investigation, coordination and preparation in a timely corrective action plan for TDSHS' Radiation Control Program regarding citations alleging improper safety monitoring of employees.

  • Representation of health care clients in the investigation, coordination and preparation of timely corrective action plans for the Texas Department of Licensing and Regulations (TDLR) regarding alleged violations of state and federal accessibility standards.

  • Representation of a health care client in the investigation and coordination of an internal investigation regarding a patient care issue involving the United States Food and Drug Administration (FDA), Centers for Disease Control (CDC) and TDSHS.

  • Representation of health care clients in the administrative appeals process involving various state health care regulations against TDSHS through the State Office of Administrative Hearings (SOAH) process.