The legal issues involved in hospital reimbursement have been a core practice area of the firm since its inception. Engagements range through representation regarding cost report issues and appeals, billing compliance advice, structuring hospital and provider arrangements to comply with reimbursement requirements, disproportionate share issues, legal defense in connection with federal and state investigations, internal compliance reviews and audits, qualification of special hospital/provider status, and other issues.

We have had considerable experience and success representing hospital and health system plaintiffs in the Pacific Northwest and around the nation, frequently in multi-plaintiff proceedings or through hospital associations, in connection with claims and recoveries based on various Medicare and/or Medicaid reimbursement law and regulations. These cases are complex, requiring an understanding of the detail of reimbursement regulations as well as the ability to collect, analyze and present extensive amounts of electronic data. This work draws upon our understanding of reimbursement law as well as hospital operations, claims processing and information. Similarly, we also represent hospitals and health systems in connection with disputes and claims involving private insurers.

Other typical engagements for hospitals and health systems encompass the variety of business transactions involved in health care. We have helped structure arrangements between hospitals and physicians, including:

• Development of medical office and other facilities to create an integrated health system campus
• Independent contractor arrangements for hospital-based as well as outpatient physician services
• Physician and health practitioner employment by integrated delivery systems and in hospital settings; physician compensation issues including incentive compensation, and fraud and abuse law compliance issues
• Development and negotiation of joint ventures with physicians and other partners for professional services and ancillary health care facilities
• Quality improvement structure and arrangements

• Corporation structuring and reorganization, including development of integrated delivery systems by engagement or employment arrangements for physician and other health professionals
• Medical staff bylaws and related matters
• Contracting with vendors, including out-sourcing arrangements for hospital services
• Development of internal compliance policies and procedures
• Emergency Medical Treatment and Active Labor Act ("EMTALA") compliance
• Defense of hospitals in connection with federal fraud and abuse investigations
• Negotiation, advice and documentation of payer contracts
• Representation of hospitals and health systems in connection with mergers and acquisitions, and sales of facilities, including due diligence reviews, compliance with charitable trust principles as they may apply to nonprofit organizations; Certificate of Need and licensing issues; anti-trust compliance, and the variety of transaction issues
• Technology purchases and licensing
• Patient care issues, including informed consent, end-of-life planning and other issues
• Tax-exempt organization issues, including compensation planning for management, and physicians; charity care, state tax issues
• Representation of hospital in connection with tax-exempt and other financing