Any provision of healthcare services or supplies generally requires some form of license, certification, or accreditation from a federal, state, or local agency or a combination thereof. Some processes are simple, while others can be incredibly complex and time-consuming.
Whatever approval is needed, our goal is to have the knowledge, experience, and relationships to ensure our clients obtain the requisite approval on the first submission and in the shortest time possible. Jackson Walker successfully represents healthcare providers, including individual practitioners and facilities, in all aspects of licensure, certification, and accreditation, including state licensure, CLIA certification, Medicare/Medicaid enrollment and participation, Joint Commission, and NCQA accreditation matters.
Processes that provide for proper credentialing and effective peer review are essential to protect patients, promote quality of care, and ensure qualified, competent staff. Jackson Walker attorneys have experience with the full range of providers and suppliers in the healthcare industry and with regulatory agencies at the local, state, and federal level. We understand the licensure process, whether for a client seeking initial licensure or an entity engaged in a complex multistate acquisition. We assist clients with preparing applications and disclosures, and we work with regulatory authorities throughout the process, negotiating complex issues where necessary.
Obtaining and protecting licensure, certifications, accreditation, and other practice privileges for healthcare professionals is crucial to the success of their careers and of the entities they work for. Peer review investigations, due process hearings, and other privilege disputes can escalate quickly, resulting in suspension or even expulsion from professional associations, the loss of hospital privileges, exclusion from participation in Medicare and Medicaid programs, forfeiture of Drug Enforcement Administration registration, and other judicial or administrative proceedings. By seeking experienced counsel early in the process, healthcare providers and entities can prevent what may sometimes be a simple misunderstanding or mistake from becoming a protracted, expensive, practice-changing event.
- Successfully represented numerous individual physicians defending investigations before Texas Medical Board.
- Appealed denial of laboratory CLIA certification.
- Successfully reinstated large specialty medical group disenrolled from Medicare program, with full retroactive reinstatement.
- Represented physician establishing concierge medical practice and disenrollment from Medicare participation.
- Represented nursing homes and home health agencies in appeals of Texas license revocation actions
- Represented healthcare professionals in connection with investigations by their licensure boards and appeals of adverse licensure actions.
- Represented healthcare professionals in the Sunset Commission’s review of their professional licensing board.
- State professional board licensure, complaints, and reporting, including: Texas Medical Board, Texas State Board of Dental Examiners, Texas Board of Nursing, Texas Board of Physical Therapy Examiners, Texas Board of Licensure for Nursing Home Administrators, Texas State Board of Pharmacy
- State Licensing for Hospitals, Long Term Care Facilities, Home Health Agencies, ASC’s, and Imaging Facilities
- Medicare and Medicaid enrollment, re-enrollment, and re-validation
- Helping providers negotiate with managed care organizations, insurers, and payors
- Long term care facility audits
- CLIA certification
- Drafting and implementation of credentialing policies and procedures
- Credentialing compliance
- Advice regarding the timing and licensure requirements for change-of-ownership applications and filings in acquisition and sale transactions
- Peer review processes, hearings, and appeals
- Joint Commission and NCQA accreditation
- Licensure for insurance companies, TPAs, and HMOs
- Preparation of and responses regarding surveys, including ACHC Medicare certification
- Healthcare Quality Improvement Act and National Practitioner Data Bank reporting requirements