We represent health plans, hospitals, physicians and other healthcare providers through a broad range of legal services. We have a registered nurse practitioner/attorney on our staff, and we have also developed close working relationships with healthcare experts in a variety of specialties, both locally and across the country for assistance in our work, which includes:
Litigation and Representation
Health Plans and Insurance (Health Maintenance Organizations, Participating Provider Organizations and Managed Care Plans)
- Litigation, arbitration and mediation on disputes including coverage, contract claims, ADA, ERISA, HIPAA, COBRA, HMO, PPACA (healthcare reform) and participating provider relationships
- Resolve coverage disputes, including eligibility, termination, fraud, medical necessity and experimental/investigational determinations
- Assist in internal and external appeals procedures and work with Independent Review Organizations
- Litigation, arbitration and mediation on disputes including collections, subrogation liens and reimbursement rights.
- Representation before the Insurance Division and Prepaid Health Care Advisory Council
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Healthcare Providers and Facilities
- Litigation, arbitration and mediation on disputes including collections, subrogation liens and reimbursement rights
- Representation in credentialing disputes and due process hearings
- Certificate of Need applications before the State Health Planning and Development Agency and related contested case proceedings
- Regulated Industries Complaints Office disputes and hearing process regarding licensure
- Emergency court orders for guardianships and emergency treatment issues
- Petition the Family Court for appointment of guardians of incapacitated persons
- Petition the Probate Court for appointment of guardians of the property and personal representatives
- Work closely with the Office of the Public Guardian, Adult Protective Services, the Attorney General's Office, hospitals, care homes and nonprofit service organizations to ensure care for incapacitated persons
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HIPAA
- File objections to requests for information that are not HIPAA-compliant
- Pursue remedies for breaches of confidentiality
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Business Advice
Health Plans and Insurance:
- Statutory and regulatory compliance work involving ADA, ERISA, HIPAA, COBRA, HMO and participating provider relationships
- Patient Protection and Affordable Care Act (and related federal health care reform) compliance work
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Medical Providers and Facilities
- Statutory and regulatory compliance work involving ADA, ERISA, HIPAA, PPACA (health care reform) COBRA, RICO, Medicare, Medicaid, QUEST, Patient Bill of Rights and Responsibilities and related programs
- Credentialing, peer review and healthcare quality issues
- Payment disputes
- Medical record-keeping practices, confidentiality and HIPAA compliance
- Medical staff bylaws and staff relationships
- Certificates of need and licensure
- Collections, liens and reimbursement rights
- Federal and state privacy laws, special classes of information (such as HIV/AIDS, mental health and substance abuse), and common law and statutory privileges
- Risk management: advice on issues regarding medical malpractice, EMTALA, Patient Bill of Rights, and confidentiality; draft risk prevention policies and informed consent forms; present seminars on risk management issues
- Physician and staff inquiries and emergency legal needs
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HIPAA
- Legal notices of privacy practices, business associate agreements, written assurances and authorizations that are HIPAA-compliant
- HIPAA Privacy Rule, HITECH Rule, HIPAA Security Rule and related compliance issues for health plans, health care providers, health care clearinghouses, employers, and other entities
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AHFI attorneys who practice in this area include:
Representative Cases
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