Senior Care

As the elderly population increases, America is facing an unprecedented demand for long-term Senior Care facilities and other providers including independent living, assisted living, home health, skilled nursing, and hospice facilities. This segment of the industry has experienced tremendous investor interest, along with increased regulatory enforcement scrutiny.

Our Healthcare attorneys are experienced advocates and counselors who understand the business, regulatory, and reimbursement climate for Senior Care facilities. There is no uniform set of rules or regulations governing Senior Care communities throughout the country, therefore a thorough legal understanding of not only healthcare laws, but real estate, tax planning, corporate, and technology laws affecting these facilities is necessary to effectuate business objectives, ensure quality patient care, and maintain compliance.

Jackson Walker takes an interdisciplinary approach to client needs and creates personalized teams across a range of practice areas. Our attorneys understand the nuances of deals, regulations, leverage, profitability, and liability protection intrinsic to the successful life cycle of a Senior Care facility. Assisting clients in acquiring, developing, and operating numerous facilities gives us insight into the modern trends of this growing market.

We represent all types of Senior Care facilities, from independent living to hospice centers, throughout the facility life cycle—negotiating everything from raising equity and funding agreements, to the acquisition of raw land, specialized facility site planning, and entitlements, to the successful management of the facility, and finally through recapitalizations or acquisition financing for additional properties or practices, as well as the necessary steps to remain compliant at each step along the way.

Our attorneys are well-versed in facility licensure and governance matters, Medicare and Medicaid reimbursement and accreditation issues, and managed care contracting. We regularly review, negotiate, and draft agreements with vendors, suppliers, and independent contractors, facility and equipment leases and purchases, admission agreements, and other business contracts and policies, with an eye toward the issues specific to the healthcare industry and its regulations.

Our Healthcare and Employment attorneys work together to address the employment and compensation issues particular to healthcare facilities and their staff, including negotiating and drafting of physician, staff, and management contracts. From privacy issues to fraud and abuse laws, we counsel clients on risk management, the establishment of cost-effective corporate compliance programs, and the necessity for self-reporting when potential issues arise.

We have considerable experience in representing healthcare clients in audits or investigations, whether internal or conducted by government agencies. Our battle-tested Labor & Employment team is also able to respond to accusations of healthcare fraud, violations of the federal Anti-Kickback Statute, and other of the various healthcare laws and regulations. We advise clients how to ensure their billing practices are compliant, properly appraise fees, establish compliant and cost-effective protocols for employees, ensure HIPAA-compliant technology, and so much more in the effort to avoid being on the other side of a fraud and abuse claim.

With one of the largest Real Estate practices in Texas, a nationally respected Healthcare team, a sophisticated Corporate & Securities practice group, creative Finance attorneys, and a notable Labor & Employment group, Jackson Walker has the ability to guide Senior Care facilities through all their legal needs.

  • Filed several hundred appeals of audit findings that could have resulted in large Medicaid recoupments from nursing home, home health, and hospice providers, successfully settling the majority on terms favorable to our clients.
  • Appealed and resolved civil monetary penalties and other enforcement remedies resulting in significant savings to our Senior Care clients.
  • Represented lenders in a variety of healthcare loan situations including skilled nursing facilities, assisted living centers in transactions that involved both private pay and governmental pay borrowers and often involved complex borrower structures separating “ownership” and “operating” components of the Borrower entities.

Jack E. Skaggs

Jack E. Skaggs

Partner, Austin

  • State and federal healthcare regulatory and reimbursement matters, including RUG audits and appeals
  • Labor and employment issues and litigation
  • License revocation appeals
  • Appeals of Medicare/Medicaid terminations
  • Appeals of state and federal enforcement sanctions such as the imposition of civil monetary penalties and denials of Medicare/Medicaid payments
  • Advice to clients in connection with audits by state and federal auditors and appeals of adverse audit determinations by RACs, MICs, and MCOs
  • Regulatory due diligence
  • Drafting operations transfer agreements, license applications, and Medicare/Medicaid changes of ownership
  • Structuring arrangements with physicians and other healthcare providers in order to avoid violations of Stark and state and federal anti-kickback laws and regulations
  • Acquisition and development of Senior care facilities
  • Financing of facilities, including complex financing structures and tax-exempt bond financing
  • Tax planning for both for-profit and not-for-profit entities
  • Management contracts, staff policies, and physicians’ agreements
  • Facility and equipment leases
  • Licensing, certification, and accreditation
  • Compliance plans, audits, and defense
  • Reimbursement matters

Related Practices