HEALTH CARE

We provide advice, counseling and litigation representation to health plans, health care facilities, and health providers in the following areas:

Health Plans and Insurance

• Work for Health Maintenance Organizations (HMO), Participating Provider Organizations and Managed Care Plans, including statutory and regulatory compliance work
• Resolve coverage disputes, including eligibility, termination, fraud, medical necessity and experimental/investigational determinations
• Litigation, arbitration and mediation on broad range of health plan disputes, including coverage, contract claims, ADA, ERISA, HIPAA, COBRA, HMO and participating provider relationships
• Assist in internal and external appeals procedures and work with Independent Review Organizations
• ERISA and COBRA compliance work
• Representation before the Insurance Division

Medical Providers and Facilities

• Advise on credentialing, peer review and health care quality issues
• Resolve payment disputes
• Advise on medical record-keeping practices, confidentiality and HIPAA compliance
• Obtain emergency court orders for health care providers, including 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
• Represent clients in court-approved sale of residences or liquidation of financial holdings
• 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
• Adviser on Patient Bill of Rights and related responsibilities
• Advise on medical bylaws and staff relationships
• Assist in obtaining certificates of need and licensure
• Assist in collections, liens and reimbursement rights
• Advise on matters involving federal and state privacy laws, special classes of information (such as HIV/AIDs, mental health and substance abuse), and common law and statutory privileges
• Draft legal documents for compliance with privacy laws
• ADA compliance work

HIPAA

• Draft legal notices of privacy practices, business associate agreements, written assurances and authorizations that are HIPAA-compliant
• Advise on issues under the HIPAA Privacy Rule and HIPAA Security Rule and related compliance issues for health plans, health care providers, health care clearinghouses, employers, and other entities
• File objections to requests for information which are not HIPAA-compliance
• Pursue remedies for breaches of confidentiality

Risk Management

• Advise health care providers and facilities on medical risk management issues, including medical malpractice, informed consent, EMTALA, Patient Bill of Rights, and confidentiality
• Draft risk prevention policies and informed consent forms
• Present seminars on risk management issues
• Respond to physician and staff inquiries and emergency legal needs

Medical Malpractice Defense

• Defend medical malpractice claims and other claims of wrongdoing against health care providers
• Represent health care providers in regards to claims involving regulatory compliance, confidentiality, qui tam, fraud and conflict-of-interest
• Consult with medical expert witnesses and conduct medical research on matters related to medical-legal compliance
• Train health care professionals to give effective testimony in legal settings

AHFI attorneys who focus in this area of practice are: