Varnum has been actively involved in the practice of health law for many years. This practice has developed largely in response to dramatic changes in the health care industry.
These changes include:
- Increasing joint activities among health care providers to create innovative programs
- Expanding governmental corporate compliance and reform initiatives
- Attempts to limit funding by government and other third-party payors
- Increasing diversity and competition in the types of health care providers
- Government enforcement of fraud and abuse
- The expansion of professional and institutional liability
Scope of Practice
Varnum represents acute care hospitals, nursing homes, DME providers, substance abuse treatment centers, mental health agencies and psychiatric facilities, numerous professional corporations, partnerships and individual practitioners in the full range of legal matters encountered by health care organizations, including the areas described below.
Acquisitions and Joint Ventures
The diversity of the firm's practice provides clients with a multitude of specialty skills in tax law, antitrust matters, corporate and partnership law, zoning and land use, public and private financing and changes in federal and state reimbursement. Attorneys in the firm use this wide range of expertise in advising clients in developing innovative health care arrangements, including hospital-physician joint ventures and integrated delivery systems, which often involve formal legal structures and financing techniques common to proprietary enterprises but novel to nonprofit institutions. Attorneys are frequently consulted to advise clients on the impact of the Anti-Fraud and Abuse Amendments, the Stark legislation and the "Safe Harbors" regulations on a particular arrangement. The firm also has experience in hospital reorganizations, multi-hospital joint ventures, the purchase and sale of nursing homes, the organization of affiliated institutions and the establishment of other health care providers. Frequent advice is also given regarding the impact of a proposed activity on a provider's tax-exempt status and the related intermediate sanction rules.
The firm's experience in antitrust law has provided a resource to health clients in advising them on issues such as joint activities among providers, medical staff credentialing, joint purchasing, exclusive contracts and acquisitions. Attorneys in the firm were actively involved in the drafting of the Michigan Antitrust Reform Act and have represented numerous defendants in important antitrust cases in state and federal court.
Managed Care/Integrated Delivery Systems
Attorneys in the firm have provided planning, licensing and contracting advice to provider networks seeking managed care contracts and have participated in the planning and establishment of HMOs and PHOs. In addition, our health law attorneys have negotiated and drafted contracts between HMOs, business coalitions, Medicaid and other payors with provider networks, hospitals, physician groups, DME providers and other providers. The firm has provided planning and implementation advice in the formation of integrated systems linking a broad range of services through one contracting entity.
The firm defends health care providers and professionals in civil and criminal investigations. This includes both pre-complaint and pre-indictment and in court proceedings brought by federal and state authorities. The firm regularly assists clients in responding to search warrants, compliance with grand jury subpoenas, trial subpoenas and administrative subpoenas issued by either state or federal officials. Attorneys in the firm have experience in defending against civil enforcement actions under the False Claims Act, Vulnerable Adult Act and in defense of numerous criminal statutes that address health care fraud and abuse. The firm's experience also extends to defense of complex qui tam actions brought by private individuals on behalf of the government.
Professional and Medical Staff Issues
Attorneys in the firm deal on a daily basis with medical staff matters including physician recruitment arrangements, drafting and revision of medical staff bylaws and guidelines for appointment and reappointment, the equitable use of credentialing criteria, negotiating and drafting of physician service contracts, appeal hearings for denial or termination of privileges, reporting and querying requirements of the National Practitioner Data Bank and advice regarding potential antitrust violations which arise in credentialing and peer review matters.
Attorneys within the firm assist physicians and professional corporations in numerous corporate matters including incorporation, shareholder agreements, employment arrangements and acquisitions. Physicians are also provided assistance in coping with prospective payment, billing and reimbursement from Blue Cross Blue Shield of Michigan, Medicare and Medicaid, medical office building matters, joint ventures, antitrust liability and credentialing and peer review issues. In addition, attention has been given to physician referral developments resulting from the Stark legislation. The firm's diverse practice has also provided physicians with assistance in intellectual property issues such a patents, trademarks and the development of new technologies.
Health Care Privacy
Attorneys in the firm are experienced in counseling health care providers and health plans in developing privacy policies and procedures to conform to the privacy rules required by the Health Insurance Portability and Accountability Act ("HIPAA"). This includes the review and preparation of business associate agreements and the drafting of notices of privacy practices. The firm's attorneys have given numerous presentations on HIPAA compliance and conducted client workshops to review procedural requirements under the Act.
The firm has experience in the various stages of contractual relations from negotiation through drafting and compliance with regulatory requirements to the settling of disputes, including breach of contract. These matters include virtually every business arrangement which health care providers enter into including contracts for professional services, leases, joint purchasing arrangements, management agreements, third-party payor agreements, agreements for the acquisition of facilities and equipment, design and construction agreements and relationships with HMOs. The firm also has particular expertise in avoiding the pitfalls in the acquisition of computer software and hardware.
Patient Care Issues
Attorneys are involved frequently with critical care issues of informed consent, refusal to consent to treatment, advance patient directives, right to die, "no code" or "no CPR" orders, determination of brain death, patients' rights, patient transfer and guidelines on treatment of special patients. Attorneys within the firm have developed an expedited process to assist providers in guardianship proceedings in probate court. Health care providers are also given assistance with respect to the release of confidential patient information, including medical records and mental health records. The firm is experienced in assisting health care providers in complying with increasing federal regulation such as the federal anti-dumping law and the new advance directive policy requirements.
The firm has assisted its hospital and senior life care facility clients in structuring and implementing tax-exempt and taxable financings through state and local governmental bond issuers. These bond financings have provided funds for such uses as new hospital construction, medical equipment purchases, professional office buildings and senior living facilities.
Quality Assurance, Insurance and Risk Management
As general or special counsel, attorneys in the firm have advised health care providers in legal issues arising out of quality assurance and risk management programs and have given advice in connection with professional liability insurance coverage, the adequacy of directors' and officers' liability insurance coverage and related issues.
Hospital Employee Health and Occupational Hazards
Attorneys advise clients on employee health issues such as medical screening and employment decisions, occupational, safety and health matters, workers' compensation and formulation of policies to minimize occupational hazards such as OSHA bloodborne pathogens standards, TB standards and hepatitis B immunization programs. Attorneys in the firm have conducted numerous educational sessions on AIDS in the workplace.
Accreditation, Licensing, and Certification
The firm is experienced in advising health clients with respect to JCAHO and AOA accreditation, state facility and program licensing, certification under the Medicare program including compliance with Conditions of Participation and in licensing/certification matters under the Michigan Insurance Code. Attorneys within the firm have represented providers in decertification proceedings, in reconsiderations of denial of certification and in matters before the Insurance Bureau.
Multiple insurers have complicated provider's attempts to obtain reimbursement. Our attorneys are frequently involved with the resolution of disputes with respect to primary and secondary reimbursement including the Medicare Secondary Payor Program and the Michigan No-Fault Act. Attorneys are also experienced in reimbursement issues arising under ERISA self-funded health plans.
Certificate of Need
Attorneys advise clients of Certificate of Need requirements for proposed construction, equipment and services of the provider. Varnum's attorneys are experienced in comparative reviews of applications and appeals from denied applications.
On a regular basis, the firm monitors proposed regulations and legislation impacting the industry. Firm attorneys are called to testify on proposed legislation in committee hearings. Attorneys within the firm have been consulted to assist in drafting proposed legislation to address specific health care provider needs.