Healthcare Industry Counseling and Disputes
The healthcare sector is under significant regulatory and economic pressure. Decades-old business practices and economic models are changing. With change comes conflict.
Litigation lawyers are effective at handling healthcare-related conflicts only if they have a deep understanding of how this unique industry works at the grassroots level. The lawyers at HHBJS know the relationships and legal landscape in this area, and recognize that healthcare disputes are unlike most other commercial disputes given unique payment and reimbursement models, Stark and anti-kickback laws, hospital/medical staff governance dynamics, and other regulatory constraints. We also know that resolving healthcare disputes confidentially and before litigation arises can be paramount. Our lawyers regularly counsel clients, therefore, on risk-management strategies to avoid litigation in the first place.
We have handled numerous disputes between hospitals and physicians, including in the highly specialized area of medical staff credentialing and other peer review “Fair Hearings” that implicate the federal Healthcare Quality Improvement Act (“HCQIA”), as well as other commercial conflicts between hospitals and physician groups arising under physician service agreements. We also have expertise in reimbursement conflicts between providers and insurers. Examples of our expertise include the following:
- Counseling hospitals and medical staffs in numerous internal “fair hearings” and lawsuits concerning physician credentialing;
- Counseling facilities and medical staffs regarding compliance with processes to ensure qualified immunity under HCQIA and the Michigan Public Health Code;
- Help design and apply progressive discipline measures for disruptive providers;
- Represented a specialty hospital in a lawsuit concerning non-compete and bed license transfer obligations in connection with Certificate of Need standards;
- Represented managed care organizations, HMOs, and third-party administrators in coverage, policy and other commercial litigation matters;
- Represented managed care organizations in government contracting and bid protests;
- Represented hospitals in disputes regarding service provider agreements between hospitals and physician groups;
- Obtained a dismissal of a putative class action against a major hospital system concerning alleged privacy and data breach claims.