Physicians and professional organizations face an extremely challenging business environment. Along with the difficulties any business faces, physicians have the additional challenge of navigating healthcare related legal issues in one of the most regulated industries in America.

Jackson Walker attorneys have the business acumen, legal skill, and healthcare law experience necessary to help physicians not only remain compliant with the many regulations but also protect and promote their interests as they build business relationships and pursue a successful, profitable practice.

We take a multi-disciplinary approach to assisting our physician clients, utilizing the considerable experience and specialized knowledge across several practice groups regarding the various challenges facing physicians and professional organizations. As a full-service firm with top-ranked attorneys in our Healthcare, Bankruptcy, Corporate & Securities, Finance, Real Estate, Tax, and Labor & Employment practice groups, Jackson Walker is uniquely qualified to guide physicians and professional organizations to meet their business objectives. We have experience with all types of practices from small to large, single or multi-specialty, clinically integrated organizations, and hospital-based physician groups, as well as hospital-employed physicians. We also work with Accountable Care Organizations and physician-hospital entities.

Transactional

Whether they wish to remain solo, pursue an alliance, or undertake a joint venture, we help physicians select the best entity form if they are just starting out, or help them restructure if their objectives are no longer served by their current form. We routinely work with practice groups to sell their practices to other providers or healthcare entities or to acquire other groups, all the while ensuring that these transactions are structured to protect the value of the practice they have built while maximizing their future opportunities.

We are familiar with the critical issues implicated by the structuring of deals, financing alternatives, valuation, and requirements in entity structure, formation, and reorganization, and we are able to implement creative and innovative solutions that further the objectives of the physicians group or professional organization. We handle not only entity formations, private placements, and capitalizations but also the requisite tax planning and financial structure for profit-based healthcare entities.

Remaining independent and complying with the many regulations can be difficult for independent and small group practices. For some, entering an alliance that allows physicians to unite together to enhance negotiations with insurers and government while improving patient care and ensuring greater regulatory compliance is preferred. We assist clients in creating, joining, or growing Independent Practice Associations, Physician-Hospital Organizations, and other joint ventures and in advising these alliances on meeting qualifications as Accountable Care Organizations for purposes of reimbursement.

Operational

Managing a physician practice is no easy task. Jackson Walker attorneys are vigilant about remaining up-to-date on the ever-changing healthcare laws and market trends in their dedication to help physicians avoid the problems that can undermine the success of their practice.

Well-drafted contracts are necessary to optimize profits in any medical practice. We counsel physicians on how to protect their interests through non-compete agreements, favorable contract terms, and solid tax planning. We are regularly involved in the drafting and negotiation of leases, purchase and sale agreements, management service agreements, coverage and service contracts, patient policies, transfer agreements, and the copious agreements with vendors and suppliers that make up the modern-day physician practice.

Labor and employment issues can undermine patient care, monopolize physicians’ valuable time, and increase exposure to liability and regulatory violations. Our well-regarded Labor & Employment practice group works closely with the Healthcare team to counsel practices on all employment issues including compensation, benefits, and compliance matters. Our attorneys are well-versed in negotiating and drafting medical directorship agreements, physician employment and recruitment contracts, and staff and independent contractor arrangements. By helping clients foster a synergistic relationship between medical staff and organizational leadership, we ensure clients have the best advantage to meet their business objectives.

We also represent physicians and professional organizations in managed care negotiations, contracting, and payment disputes. Our Healthcare attorneys have a stellar track record when it comes to ensuring that a provider’s claims are paid. Whether documents need to be reformed, a process needs to be redesigned, or the plan contract needs to be renegotiated, we have the experience, know-how, and relationships with Payors and Plans to see that the proper systems are in place for claims to be paid promptly and in full. We are also well versed in the processes for facilitating reinstatement for terminated providers.

We routinely assist practices in resolving licensure and credentialing issues affecting physicians and medical staff, including representing physicians in actions by state licensure boards seeking to impose sanctions and other disciplinary action against physicians, allowing physicians to continue to practice medicine without worrying about administrative burdens or interference.

The healthcare industry has become enmeshed in technology, with technological capabilities not only becoming part of the medical standards of care but also being implicated in a number of regulatory requirements. Successful physicians must be at the forefront of technological advancements in medicine and in office management. Our attorneys counsel physicians and professional organizations on various aspects of technology in healthcare, including telehealth advancements. With rapid changes in technology, telemedicine has transformed into a complex integrated service. We guide clients through the myriad of licensure, regulatory, fraud and abuse, and billing issues confronting physicians in the telemedicine arena, and the interaction of telemedicine with electronic medical records, including HITECH and HIPAA concerns.

Regulatory

Federal and state regulations impact virtually every operational aspect of a physician practice. With the level of regulatory scrutiny of healthcare practices today, it is of vital importance that physician agreements and business relationships comply with Stark and Anti-Kickback laws, as well as the myriad of other fraud and abuse laws. We advise clients on the circumstances that require self-disclosure of potential fraud and abuse issues and have significant experience defending fraud and abuse claims brought on behalf of the government against physicians and professional organizations. Our representation of physicians extends to dealing with government agencies including the U.S. Department of Health and Human Services, OIG, IRS, State Medicaid Fraud Control Units, and the FBI.

Compliance plans are another critical element to a successful physician practice. Our attorneys shape corporate compliance plans to fit the size, type of practice, and budget to minimize costs while maximizing protection from liability. Likewise, we combine our deep knowledge of HIPAA and other privacy laws with broader experience in healthcare, cybersecurity, employee benefits, litigation, and liability management to deliver tailor-made, cost-effective solutions to ensure compliance with health information privacy and security regulations.

As important as avoiding regulatory challenges is ensuring compliance with the regulations that can compromise payment. Solid legal advice is particularly important in the current atmosphere of reduced reimbursements and increased fraud and abuse investigations. We assist providers in establishing the procedures and protocols that will avoid most reimbursement issues. When issues do arise, we are there to see clients through challenges from public and private payors alike.

Whether trying to recoup payments, avoid penalties, or successfully resolve an investigation, Jackson Walker’s Healthcare team has the resources and know-how to help ensure physicians are reimbursed as expected.

Transactional

  • Represented a very large multi-specialty physician clinic with numerous locations in the private placement offering of new ownership interests, setting up its governance structure, and creation of its Accountable Care Organization (ACO).
  • Represented a public hospital company in unwinding several physician joint ventures that owned and operated major medical equipment.
  • Represented a for-profit company in negotiating a joint development agreement with a specialty cancer hospital for the production of radioisotopes and research regarding same.
  • Represented numerous physicians, physician groups, and oral surgeons in joining, merging, and buying into various medical practices.
  • Represented a children’s specialty hospital in the creation of its 5.01a Texas Certified Nonprofit Healthcare Organization and acquisition of over 30 multi-physician group practices valued over millions of dollars in the aggregate and the employment of over 120 pediatricians for operation of an integrated healthcare delivery system.
  • Represented a radiology practice in unwinding an unsuccessful merger with another practice.
  • Represented a radiology practice in the amendment of its partnership agreement to implement new provisions for governance, buyouts, restrictive covenants, senior physician status, and different classes of equity and voting partners.
  • Represented a radiology practice in the formation of an management services organization and sale of interests in the management services organization to private equity investors.
  • Represented senior physician shareholders in the buy-out of their interest in a medical practice and its subsidiary management company prior to the sale of the practice and management company.
  • Structured a network of financially and clinically integrated physicians offering cardiovascular services under bundled pricing arrangements.
  • Represented single specialty physician groups in rollup transactions involving the sale of medical assets to another physician practice group and investment in a related management services organization.
  • Represented various spine and neurosurgeons in investment in joint ventured hospitals with physician and non-physician owners.
  • Represented a national for-profit hospital company in its initial limited partnership offering for one of its medical centers and a subsequent follow-up offering.
  • Represented a group of five orthopedic surgeons in their investment in an orthopedic ambulatory surgery center.
  • Represented a group of over ten pediatric orthopedic surgeons in their investment in an ambulatory surgery center for orthopedic matters.
  • Represented a for-profit company in structuring its joint ventures for radiation therapy centers in Texas and other states providing IMRT services for physician group practices, development of the purchased services and management services agreements, and drafting of the appropriate private placement memorandums and other offering documents.
  • Represented a public hospital company in unwinding several physician joint ventures that owned and operated major medical equipment.
  • Represented a national for-profit hospital company in its initial limited partnership offering for development of a birth center at its Houston women’s hospital.
  • Represented an oncologist in purchasing a limited liability company interest in an  cancer center venture.
  • Represented an affiliate of a specialty cancer center that provides cancer center management and therapeutic services in a joint venture with another cancer center.
  • Represented a large anesthesiology group in restructuring its professional limited liability company and buy-sell agreements, adding new members, and satisfactorily resolving issues with a departing member.
  • Represented a large radiology group practice in restructuring its limited liability partnership and buy-sell agreements, adding new partners, and developing its new independent contractor agreements.
  • Represented numerous physicians and oral surgeons in joining and buying into various medical practices.

Operational

  • Formed and represented multiple large physician practices to serve as Medicare Advantage provider panels.
  • Represented innumerable healthcare providers as well as individual physicians, dentists, oral surgeons on both the employer’s and employee’s side in employment, retention, coverage, and independent contractor agreements.
  • Represented a physician organization, whose physicians provide medical services around the globe, particularly in remote locations, utilizing telemedicine technologies.
  • Represented pathology practice in development of new protocols and operating standards after a change in law allowing direct distribution of test results to patients.
  • Represented healthcare professionals in connection with investigations by their licensure boards and appeals of adverse licensure actions.
  • Represented physician establishing concierge medical practice and disenrollment from Medicare participation.
  • Represented a for-profit company in structuring its joint ventures for radiation therapy centers across the nation to provide IMRT services for physician group practices, drafting of the appropriate private placement and other offering documents, and development of the purchased services and management services agreements
  • Represented numerous orthopedic surgeons, anesthesiologists, pediatricians, radiologists, and other specialists in sales of their practices and/or employment agreements
  • Represented a for-profit company in drafting of the appropriate private placement and other offering documents for its fertility clinic joint ventures in Texas and other states, and development of the management services, employment, billing & collection and other agreements necessary for the venture.
  • Represented physician organizations in the development of patient health information technologies such as patient portals.
  • Represented multiple physician practices in negotiations with managed care and other payors.
  • Represented various hospitals, medical groups, and physicians from each perspective in numerous physician relocation and recruitment arrangements.
  • Represented a medical school in developing a services agreement to provide telemedicine services to a maritime company’s ships overseas.
  • Represented a physician organization, whose physicians provide medical services around the globe, particularly in remote locations, utilizing telemedicine technologies.
  • Represented multiple entities, including both physician entities and private equity investors, in establishing telemedicine businesses.

Regulatory

  • Represented an orthopedic surgery practice in investigating possible billing irregularities by physician members and coders.
  • Established compliance programs for large and small physician organizations.
  • Successfully represented numerous individual physicians defending investigations before Texas Medical Board.
  • Assisted a large specialty medical group to restore its revoked Medicare certification within one week, with no loss of revenue.
— Attorney News

Dallas Women Lawyers Association Honors Mary Emma Karam With 2018 Louise B. Raggio Award

  • General business planning, operations, and contracting
  • Physician/hospital joint ventures
  • Acquisition, mergers, and disposition of practices
  • Formation of Medicare and commercial accountable care organizations (ACOs), independent practice associations (IPAs), physician-hospital organizations (PHOs), and other provider networks
  • Start-up medical practices
  • False Claims Act and qui tam litigation
  • Regulatory and enforcement proceedings
  • Structuring physician practices, including hospital privileges
  • Self-referral restrictions under state and federal law
  • Governance and restructuring
  • IPAs and medical foundations
  • Licensure, certification, and accreditation
  • Counsel regarding acquisition and operation of medical office buildings and other healthcare real estate assets
  • Peer review and reporting
  • Practice management and compliance
  • Physician syndication agreements
  • EHR/EMR transactions
  • Joint venture agreements
  • Sale and purchase agreements
  • Assisting sponsors of ERISA self-insured plans in amending plan documents for HIPAA compliance
  • Medical staff credentialing, hearings, and appeals
  • Physician recruitment and contracting
  • Rate issues
  • Professional licensing, credentialing, and discipline
  • Federal and state confidentiality requirements, including HIPAA and HITECH
  • Representation of community clinics and FQHCs
  • Drafting and implementing medical staff bylaws, rules, and regulations
  • Drafting and implementing compliant policies and procedures
  • Evaluation, development, implementation, and operation clinical integration programs
  • Review and negotiation of vendor and service agreements
  • Advise on structuring business operations to minimize risk and exposure to liability
  • Drafting and negotiation of service line management joint ventures and service line co-management agreements
  • Drafting and negotiation of professional services and coverage agreements, medical directorship agreements, physician recruitment and retention agreements, employment agreements, independent contractor agreements, and exclusive provider agreements