Health Care

Modernization of a hospital plant, the development of a new nursing home or the expansion of an existing nursing facility, or the acquisition by hospitals of major and sophisticated medical diagnostic equipment (such as linear accelerators, imaging equipment and lithotripters), all require Certificate of Need ("CON") experience before the Commission on Hospitals and Health Care. Murtha Cullina obtained the first CON in the State of Connecticut for a mobile MRI service to be shared by three hospitals and also assisted in obtaining the first CON granted for a specialized AIDS facility in the state. The firm's lawyers have been successful in obtaining CONs for more than 2,500 nursing home beds for both existing and new nursing home facilities, and have assisted hospitals and nursing homes in the financing and construction of numerous Certificate of Need authorized projects.

In recognition of the growth and need of our aging population for special types of housing with ancillary health care services, our attorneys have assisted health care institutions and real estate developers in the development of various forms of retirement housing, including continuing care retirement communities with entrance fees, rental and other models (which may or may not offer assisted living services and nursing home care), as well as free standing assisted living facilities. And, because the delivery of health care services is labor intensive, the firm's health care group includes experts in labor relations, employment relations, employment discrimination, workmen's compensation, retirement plans, wage and hour law and professional practice plans.

Non-profit hospitals have transformed the traditional section 501(c)(3) acute care medical service role to encompass diverse health care activities and for-profit unregulated activities. Working with the firm's health care attorneys, Murtha's tax and corporate lawyers have assisted numerous hospitals and nursing homes in establishing corporate structures that have accommodated the diversified activities of affiliate corporations which implement new ventures such as (1) the development of medical office buildings, (2) separate cardiology and billing practices, (3) the creation of imaging joint ventures, and (4) other entrepreneurial activities.

Murtha Cullina counsels clients in their compliance with EMTALA, and also represents clients in enforcement actions by the Office of Inspector General. Murtha also has developed an educational presentation for the benefit of members of hospital medical staffs, which it offers without charge to its hospital clients.

Hospitals and nursing homes have sought methods to save energy costs by developing innovative projects which produce useful energy through cogeneration or other means. In conjunction with Murtha's environmental, utilities and communications groups, the health care attorneys have assisted numerous institutions in the development of various forms of cogeneration projects. This cost-consciousness as well as the firm's expertise has now been focused on the health care provider community. Additionally, public concern with the disposal of biomedical wastes by nursing homes, hospitals and physician groups has been a recent area of focus for both the firm's health care and environmental practices.
 

Several years ago, Murtha Cullina LLP anticipated the need to prepare its clients for fundamental changes in the health care system by the formation of its Health Care Department: an interdisciplinary team of experienced lawyers, each with identifiable expertise in the various areas of the law which directly impact on the development, financing, licensure, patient care delivery, quality control, reimbursement and day-to-day operation of both health care institutions and individual professional practices.

In addition to providing assistance to clients with respect to traditional legal issues, the firm has been called on more recently to respond to the demands of a dynamic health care marketplace by assisting hospitals and other health care institutions in completing mergers and corporate reorganizations and in the formation of innovative relationships between all categories of health care providers: the formation of integrated delivery systems, including the development of PHOs, MSOs, IPAs, hospital networks and fully integrated physician groups.

The team approach to client concerns enables Murtha Cullina LLP to provide timely response to client inquiries since team members have an in-depth knowledge of all of the important segments of the health care industry. The Department's practice philosophy recognizes that the health care delivery system deals foremost with profound questions of ethics and clinical quality but is also interrelated with medical economics and third party reimbursement. The Department's interdisciplinary membership includes lawyers with experience in solving problems unique to the health care field: third party reimbursement, informed consent, death and dying issues, corporate reorganization of non-profit and for-profit facilities, medical staff relations, shared services, equal access and patient's rights issues, confidentiality of medical records, antitrust, and Medicare and Medicaid fraud and abuse issues.
 

The firm has developed extensive resources to assist its clients in complying with HIPAA, including "The Privacy Officer's Manual" and a "Manual of Forms and Policies". There are several versions of these manuals to optimize their relevance in particular circumstances.

The firm is assisting providers and also employers who maintain health plans with their HIPAA compliance efforts.

Murtha Cullina represents providers of home health care in all aspects of their legal needs, including regulatory, reimbursement, antitrust and contracting.

Murtha Cullina has regularly counseled nursing homes and hospitals in successfully resisting union organizational activity. The firm also counsels nursing homes and hospitals in avoiding employment law liability in areas such as worker's compensation and employment discrimination, including an increasing focus on the employment-at-will doctrine. The firm's labor and employment law group members regularly review and revise personnel practices and wage and hour plans, and also advise health care professionals on the economic and tax aspects of retirement planning.

Hospitals, physicians and managed care plans are joining forces to contain health care costs by the formation of integrated delivery systems which coordinate the delivery of primary care and specialty physicians' services with a hospital's outpatient and inpatient services. Collaboration by physician-controlled entities with hospitals enables an integrated approach to managed care contracting and preserves volume and market share for the integrated network's participants. Murtha Cullina has been active in this movement. Our experience has included the provision of legal services along the full spectrum of physician-hospital collaboration, including the formation of management services organizations ("MSOs") (to enable hospitals to offer recruitment and retention practice enhancements to physicians consistent with anti-kickback and IRS limitations) to the formation of PHOs and more integrated entities suitable for hospital/physician collaboration, including economically integrated clinic model physician groups.
 

Murtha Cullina has assisted numerous hospitals with issues involving credentialing of physicians, establishing valid rules and procedures to limit access to the medical staff, medical staff privilege disputes, and trade regulation and antitrust questions associated with this subject. The antitrust immunity afforded to participants in professional review activities by the Health Care Quality Improvement Act of 1986 and the availability of information on medical staff applicants and members from the National Practitioner Data Bank have been the subject of increased attention.
 

Murtha Cullina's extensive experience in hospital joint ventures, hospital affiliation agreements and other hospital collaborative arrangements enabled the firm to serve hospital clients in several major hospital mergers and acquisitions that have been consummated in Connecticut in recent years. These hospital consolidations involved the transfer of control between two hospitals, the merger of two inner city teaching hospitals and the acquisition of a municipally owned and operated hospital by a private non-profit community hospital. The firm's experience with legal issues across the broad spectrum of hospital operation and development enabled us to complete the extensive due diligence investigations that are required in these complex transactions.

When long-term care facilities are transferred, buyers, sellers and lenders are assisted by Murtha attorneys in adapting the transaction to the change of ownership regulations imposed by the Department of Public Health and Addiction Services, the third party reimbursement requirements of the Department of Social Services ("Medicaid"), and the federal Department of Health and Human Services ("Medicare"). Additionally, institutions that acquire, transfer or develop real estate must comply with the provisions of the Connecticut Environmental Transfer Act relating to hazardous waste. Our health care lawyers work with our environmental attorneys in counseling sellers, purchasers and lenders with respect to compliance with those requirements.
 

The firm believes that one of the key challenges for providers is addressing patient care and risk management issues. The firm has partnered with risk managers and their association to develop educational presentations and materials on this subject.

It also represents providers before regulators in matters relating to patient care deficiency allegations and licensure.
 

Murtha Cullina’s Physician Practice Group has extensive experience advising physicians and physician groups. We are legal advisors and business counselors. We know that physicians are among the most highly regulated businesses in America today. We know the regulations that govern you. We know your business.

As a physician, you are faced with decisions requiring common business sense and a working knowledge of the vast regulatory scheme physicians must work within. To make your tasks easier, our attorneys can give you guidance in the following areas:

REGULATORY

• STARK
• Anti-Kickback
• Medicare billing
• Medicare, RAC and Commercial payor audits
• Accountable Care Organizations
• HIPAA, including HITECH
• DPH – licensure and disciplinary matters
• Certificates of Need - OHCA
• Hospital credentialing

CORPORATE/CONTRACTUAL

• Employment Agreements
• Covenants Not-to-Compete
• Buy-sell agreements
• Service agreements
• Mergers and acquisitions of practices
• Operating agreements or bylaws
• Physician/hospital networks
• Joint venture arrangements with private entities, other physicians and hospitals
• Formation of ASCs
• Financing transactions
• Large software licenses
• Cloud hosting agreements

INSURANCE

• Insurance coverage matters
• Managed care contracting

EMPLOYMENT

• Discrimination matters
• Hiring/firing guidance
• ADA
• Immigration
• Covenants Not-to-Compete

EMPLOYEE BENEFITS

• ERISA plans
• Non-qualified plans
• Health insurance
• Affordable Care Act
• HIPAA, including HITECH

GENERAL LITIGATION

REAL ESTATE

• Leasing
• Acquisitions
• Sales
• Financing

Murtha means more understanding of your business and regulatory needs. We can help.

The firm assists clients with reimbursement issues including medicare, medicaid, commercial payors and other third party payors. In these areas, it is extensively involved in counselling, contract negotiations, litigation, adminsitrative appeals (including the Provider Reimbursement Review Board and state administrative bodies), and arbitration. This experience has included litigation on behalf of groups of providers as well as claims on behalf of particular providers, PHOs and IPAs.

The firm also counsels and represents providers in criminal and civil proceedings involving medicare and medicare fraud and abuse issues.
 

The health care industry has become a target market of tax-exempt bond underwriters, turn-key developers and conventional financing sources as well. Murtha's health care practice has assisted nursing homes, hospitals and physician groups in the negotiation and completion of all types of financing. These programs include tax-exempt obligations, and structures using various forms of credit enhancement, such as letters of credit, bond insurance, bond guarantees, and the FHA Section 232 coinsurance program, all of which assist clients in minimizing their net interest rate cost. Department members regularly assist institutional clients with Connecticut Health and Educational Facilities Authority ("CHEFA") and Connecticut Development Authority ("CDA") financings.
 

Our attorneys have lectured and presented extensively on matters relating to tax exemption law as applied to health care organizations.

We have represented clients seeking counsel on issues relating to tax exemption, as well as clients faced with 501 (c) (3) audits.

It also advises clients on issues relating to long term care.