Health Care Industry

Guided multiple hospitals and health systems through the Medicare appeals process for Recovery Audit Contractor (RAC) claim denials and overpayment determinations. This matter involved preparing hospitals for RAC audits and managed appeals involving a wide array of billing issues through the Administrative Law Judge hearing process and Medicare Appeals Council (MAC), when necessary.

Created 457(f) plans on behalf of several health systems.

Advise and assist Indiana's largest private, not-for-profit health system with three projects that are among the largest construction projects the system has ever undertaken, with total costs expected to exceed $1.3 billion over several years. The first project involves construction of a new campus location in the downtown area. The second project involves a new facility on a university campus. The third project involves renovating 150,000 square feet of the vacated children’s hospital to create a maternity hospital. Bricker’s role is to provide the legal services specific to the construction of health care facilities, while Indiana co-counsel is expected to provide more general construction advice.

Obtained a favorable decision from the IRS on behalf of a nonprofit, public sector managed care company involving an innovative legal approach to acquiring tax exempt status.

Represented a hospital in a case where a terminated employee accused the hospital of violating the Family Medical Leave Act (FMLA). We defended the hospital's leave of absence policy and its right to expect employees to comply or be terminated. Our client secured a favorable settlement in mediation three weeks before trial. 

Represented a Cayman Island segregated portfolio insurance company that insures providers against professional liability and its shareholders in connection with the sale of shares to a significant Michigan-based health care company. There were numerous financial, regulatory and international law issues associated with the transaction. 

Represented a large non-profit health care company as a secured creditor in a Delaware-based Chapter 11 case. This matter involved assumption and assignment of executory contracts, cure and setoff issues.

Represented a large hospital system in successfully dealing with an FTC investigation of an acquisition of a physician specialty practice group. 

Represented a trade association in resolving an FTC investigation into alleged restrictive association requirements. 

Retained to file an amicus curiae brief on behalf of three organizations in support of the constitutionality of Ohio's noneconomic damage caps applicable to medical negligence cases.

Successfully defended nursing home in a lawsuit filed by a pharmaceutical supplier based on the defense that the price charged was excessive and not related to maximum allowable cost (MAC) or average wholesale price (AWP) for brand name and generic drugs. 

Successfully defended hospital against a $4.5 million claim brought by a nursing home seeking to recover lost future profits arising out of failed transfer of Long Term Care Hospital (LTCH) beds from the nursing home to the hospital due to a moratorium imposed by the Center of Medicare & Medicaid Services.

Assisted with drafting and negotiating design-build contract for a private hospital. Project value exceeded $320 million.

Advised a public hospital regarding the evaluation of bids.

Obtained a complete defense verdict for a hospital system, resolving a complicated multi-party seven-year dispute. 

Represented a hospital system in multiple arbitration proceedings in a dispute with national payor relative to the implementation of sequestration cuts imposed following passage of the budget deficit reduction act.

Represented a health care provider in a dispute with a national payor relative to medical necessity claims denials. 

Was lead outside counsel for a health care technology startup and assisted in raising over $20 million.

Prepared an amicus brief on behalf of the American Hospital Association in support of the U.S. Department of Health and Human Services (HHS) interpretive rule providing guidance on the scope of the exclusion of orphan drugs from 340B discounts. 

Assisted in the development of a state-wide database for health care information reports, including the creation of policies and agreements and compliance with regulatory requirements (including HIPAA). Also worked to revise protocols for state-to-state relationships, the sharing of data and related data sharing agreements.

Assisted a large health system with the system-wide implementation of an electronic health records (EHR) system, ensuring legal and regulatory compliance, HIPAA security and continuity of patient care. 

Represented a county hospital that became affiliated with a large health care system, obtaining all regulatory approvals, overseeing self-disclosure of potential Stark issues and assisting with the payoff of outstanding bonds.

Provided ongoing antitrust advice in connection with the formation of a statewide network of six regional health care systems, which is one of the larger health care joint ventures in the country. 

Advise public hospitals regarding responses to requests for a large number of public records.

Served as lead counsel to an Ohio-based health network in developing a unique physician-led management services organization (MSO) providing day-to-day operation and management of multiple breast health centers. This unique MSO also developed a clinically integrated incentive strategy within the network of primary care and OB-GYN physicians to implement a physician-designed evidence-based patient protocol to enhance breast health, early detection and prevention in the health network's market area. 

Assisted with transitioning all assets of a not-for-profit developmental disability service provider to another not-for-profit developmental disability service provider, forming one of the largest developmental disabilities service providers in Ohio in terms of revenue and consumers served.  

Prepared template architect/engineer, construction manager, contractor and other consultant agreements for both public and private hospitals to be used for different project delivery methods and with projects of varying sizes and scope.

Represented a health care client in competing lawsuits between a two health care systems, with each of the health systems pursuing the other in Ohio and West Virginia. The dispute involved allegations that one of the systems had conspired with West Virginia hospitals to open long-term acute care hospitals (LTACH) in violation of an agreement that it was only to operate an LTACH facility on the other health system's medical campus.

Testified before the Ohio House and Senate on multiple occasions in support of legislative changes that would benefit the medical community.

Over two decades of experience defending hospitals, nurses, physicians, and other medical providers against medical negligence and wrongful death claims in various Ohio courtrooms.

Successfully defended hospital in lawsuit brought by debtor patients for alleged unlawful collection of debts discharged in bankruptcy.

Represented a nonprofit community hospital in becoming affiliated with a large hospital system, obtaining all regulatory approvals.

Advised hospitals responding to meaningful use audits of the Centers for Medicare & Medicaid Services (CMS) electronic health record incentive payment program, which required analyzing compliance with regulatory requirements for receiving such payments, assisting with preparation of responses and guiding hospitals through the audit appeal process, when necessary.

Counselled public hospital client through the negotiation of an architect agreement.

Successfully defended, through appeal to the United States Court of Appeals for the Sixth Circuit, a qui tam action brought under the False Claims Act on behalf of a hospital system who was alleged to have violated the Health Information Technology for Economic and Clinical Health (HITECH) Act by improperly certifying its compliance with the HITECH Act in exchange for receiving meaningful use payments.

Assisted an independent, government-owned community hospital in its pursuit of a unique and strategic partnership to keep it viable and positioned to survive the pressures of a reforming health care delivery system. This process involved soliciting and evaluating proposals from potential strategic partners, engaging with consultants, advising on legal issues related to the hospital's government ownership, and, ultimately, preparing and negotiating the strategic affiliation agreement. 

Successfully defended a hospital and its employees in a jury trial case where a patient's estate claimed that the patient had received deficient care and had been discharged from the hospital prematurely. The patient's estate claimed that the patient died from a massive internal bleed that additional hospitalization would have prevented. Following a week and a half trial, the jury returned a defense verdict. 

Represent large teaching hospitals and other non-teaching hospitals on Medicare reimbursement matters and cost report appeals, which include appeals of administrative agency decisions and various court appearances.

Worked with an operator of long-term acute care hospitals to resolve a dispute with an insurance carrier regarding Medicare and Medicaid plan payments. We identified the source of payment discrepancies, corrected prior incorrect billings and put appropriate measures in place to prevent future occurrences. 

Negotiated a settlement of Medicare reimbursement underpayments with the federal government on behalf of two large health systems.

Defended hospital in lawsuit brought by physician group seeking to recover $8 million in lost future profits due to alleged interference with physician group's business relationship with referring physicians and patients. 

Provided guidance to a health care client related to operating their PACs, hosting candidate events and corporate participation in the national convention, ballot issue activity or independent election activity.

Prepared and filed the application for licensure in Ohio, obtaining approval of the application. Coordinating with counsel from other states, we also advised the client on a number of strategic issues.

Represented governmental hospital and acted as borrower's counsel in $25 million hospital revenue bond financing, successfully negotiating a unique provision that permitted the hospital to convert to private nonprofit status in the future without having to obtain the consent of the bondholders.

Acted as borrower's counsel for a municipal hospital in the issuance of $35 million in revenue bonds.

Served as lead counsel in the acquisition of a nonprofit health system by a health corporation, negotiating the transaction, drafting all corporate documents, conducting due diligence review and completing all regulatory filings.

Drafted a unique school district-hospital agreement to provide educational opportunities to high school students.

Serve as counsel to the Ohio Health Information Partnership and assist with all aspects of its operation of a health information exchange (CliniSync).

Obtained a defense verdict for a hospital in a lawsuit alleging invasion of privacy and violation of the Health Insurance Portability and Accountability Act (HIPAA) for alleged unlawful disclosure of personal health information. 

Represented a large hospital in an ERISA case against the plan, employer and third-party administrator in pursuing benefits for patient treatment. 

Represented a pharmaceutical developer in a private arbitration, securing an award of over $1 million, including attorney fees, against a global pharmaceutical manufacturer. 

Defended hospital in lawsuit brought by physician group seeking to enjoin hospital from terminating physician group’s exclusive service agreement with hospital. 

Trial Counsel for local county boards serving persons with developmental disabilities in defense of an action brought by private providers seeking to eliminate service contracts between county boards and private providers as mandated by state and federal Medicaid law. 

Served as trial counsel to county boards and individual taxpayers to enjoin Ohio Department of Job and Family Services administrative rules that set Medicaid reimbursement rates in excess of the provider's usual and customary rate.

Coordinated and led twenty-six separate litigation matters challenging statewide initiative petitions concerning the public purchase of pharmaceuticals.

Successfully argued before the Ohio Supreme Court, establishing that hospitals cannot be primarily responsible for independent providers.

Advised hospitals on potential False Claims Act exposure; also represented the Ohio Hospital Association and the American Hospital Association in successfully challenging the government's use of the False Claims Act in Ohio's laboratory unbundling litigation.