People

Joshua M. Gilbert

Joshua Gilbert is a health care attorney who regularly assists hospitals, hospices and other health care providers in a variety of operational, transactional and regulatory matters. Josh’s practice specifically includes Medicare and Medicaid reimbursement issues and cost report appeals, EHR implementation and Meaningful Use compliance, and HIPAA privacy and security. Experienced in a variety of federal and state regulatory issues, he frequently advises on physician employment and services contracting, day-to-day operational issues, and compliance matters for hospice and long-term care facilities.

Experience

  • Health system and physician-owned hospital affiliation

    Prepared several options for a health system and physician-owned surgical hospital to affiliate in a secondary market. Provided regulatory advice, including an analysis of potential Stark Law and Anti-Kickback Statute compliance issues, as well as antitrust and federal tax law advice.

  • HIPAA policy review

    Reviewed the HIPAA policies of two regional health plans to ensure continued compliance with relative state laws. These regional health plans were part of a national health plan’s portfolio and also required compliance with the national plan’s policies on HIPAA privacy, security and breaches.

  • Central Ohio COVID-19 surge facility

    Managed, coordinated and prepared legal arrangements necessary to establish a hospital facility for use by several of central Ohio’s primary hospital systems. Facilitated negotiations among three health systems, the surge facility’s primary owner and its food service contractor.

  • HIPAA compliance program overhaul

    Conducted an assessment of a large physician practice’s existing HIPAA policies and procedures, later making recommendations for and drafting revisions and additional policies. Trained the organization’s HIPAA privacy officer and formalized roles and responsibilities for the privacy officer, security officer, and HIPAA privacy and security committee.

  • Financing and conversion of public hospital to nonprofit business

    Assisted Adams County Regional Medical Center in its conversion from a county-owned hospital to a private health care provider. The transaction required obtaining bond financing for the acquisition and conversion of the hospital facilities, real property and assets, and resulted in the continuation of local care for Adams County residents. 

  • Hospital system arbitration

    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.

  • Medicare reimbursement matters

    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.

  • CMS meaningful use audits

    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.

  • Management services organization development

    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. 

Professional & Community Activities

  • Member, American Health Law Association

Presentations & Published Works

  • Speaker, "Interoperability Rule Implementation and Compliance," Ohio Hospital Association Webinar, September 2020
  • Author, "CMS Makes Big Changes to RAC Program," 2015
  • Author, "New CMS Guidance and FAQs on Switching Electronic Health Records Vendors," 2015
  • Author, "In-depth Summary of Stage 3 Meaningful Use and CEHRT Rules," 2015

Bar Admissions & Activities

  • Admitted, State of Ohio, 2014
  • Member, Ohio State Bar Association
  • Member, Columbus Bar Association

Education

  • University of Pennsylvania Law School (J.D.), 2014
  • Wharton School at the University of Pennsylvania (Certificate in Business, Economics and Public Policy), 2014
  • Taylor University (B.A., Political Science), 2011