Duckor Metzger & Wynne, APLC serves the healthcare industry by providing both transactional and compliance advice as well as healthcare litigation counsel.
Healthcare Transactional and Compliance Advice
As one of the most highly regulated industries in the country, providers in the healthcare industry face unique legal and regulatory challenges. DMW’s healthcare attorneys counsel all types of healthcare providers, focusing representation on providers of healthcare services, rather than payors or institutions, including:
- Physicians and Medical Groups
- Allied Health Professionals
- IPAs
- Hospices
- Laboratories – Clinical and Anatomical
- Physician-Owned Laboratories
- Home Health Agencies
- Ambulance Suppliers
- Durable Medical Equipment Suppliers
- Diagnostic Testing Facilities
- Ambulatory Surgery Centers
DMW’s healthcare attorneys provide comprehensive legal counsel covering all aspects of a provider’s business and practice, from ongoing operational issues to licensing and certification, regulatory compliance or mergers and acquisitions.
DMW provides the following services:
Medical Groups
- Professional Corporation/Partnership Formation
- Buy-Sell Arrangements
- Ownership Succession
- Employment and Independent Contractor Agreements
- Management Services Agreements
- Impaired or Disruptive Physicians and Fair Hearing Procedures
- Recruitment, Hiring and Termination of Physicians
- Purchase or Sale of Practice
- Billing and Collection Practices
- HIPAA and State Privacy Laws
- Windup and Dissolution
- Shareholder Disputes
- Exclusive Contracts
IPAs
- Entity Formation
- Strategic Alliances
- Managed Care Contracting
- Clinical Integration
- Antitrust Analysis/Messenger Models
- Management Services Agreements
- Fair Hearing Procedures
- Credentialing
Individual Physicians
- Employment and Independent Contractor Agreements
- Buy-Sell Agreements
- Physician Deselection
- Provider Enrollment
Laboratories
- Suspension or Revocation of CLIA and/or State Licensure
- State Survey, Certification, Accreditation or Licensing Issues
- Response to Surveys and Statements of Deficiencies
- Compliance Plans
- Physician Owned Laboratories
- Medical Director Agreements
- Purchase or Sale
Hospices
- Survey, Licensing and Certification Issues
- Appeal of Payment Denials Based on Medical Necessity
- Appeal of Payment Denials Based on Conditions of Participation
- Compliance Plans
Regulatory Compliance
- Fraud and Abuse Analysis
- Stark and Anti-Kickback Analysis
- Compliance Plans and Guidance
- Defense of Qui Tam Actions
- Defense of Government Investigations
- Voluntary Disclosures
- Provider Enrollment
- Credentialing
Reimbursement and Audit
- Audit of Billing and Collection Practices
- Audit of Compliance Programs
- Managed Care Contracting
- Medicare, Medi-Cal or Private Payor Audits
- Administrative Appeals of Overpayment Audits
- Medicare and Medi-Cal Reimbursement Analysis
- MAC & RAC Audits
Healthcare Litigation
DMW’s healthcare trial attorneys have an in-depth and working knowledge of the myriad of federal and state laws that govern healthcare providers and have litigated numerous cases before federal and state agencies and courts, as well as in private arbitrations. DMW represents individual providers as well as medical groups, IPAs and some payors in complex litigation.
The Firm’s healthcare attorneys regularly handle the following types of matters:
- Defense of Government Investigations
- Response to Government Subpoenas or Civil Investigative Demands
- Defense of Qui Tam Actions
- Physician Termination or Deselection
- Suspension or Revocation of Licenses or Certifications of Healthcare Providers
- Defense and Appeal of Medicare, Medi-Cal or Private Payor Audits and Overpayment Demands
- CLIA and State Law Laboratory Licensing and Certifications Actions
- Managed Care Litigation
- Provider Disputes with Third-Party Payors
- Ownership and Governance Disputes
- Contractual Disputes Between Providers (Employment, Shareholder or Partnerships)
- Contractual Disputes Between Providers and Third-Parties (Health Plans and Hospitals)
- Representation of Payors in Billing Disputes with Out-of-Network Providers