Healthcare

EXPLORE

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Kelly M. Hagemann
Senior Associate
TELEPHONE NUMBER
714-557-7990
EMAIL ADDRESS
khagemann@mrllp.com

Overview

M&R understands the ins-and-outs of the healthcare business, not to mention the short- and long-term goals of the healthcare providers we serve. Our healthcare attorneys leverage their comprehensive knowledge of the space to successfully handle matters involving health plans, insurers, providers, third-party administrators and other healthcare-related entities, including laboratories and imaging centers.

Our attorneys have litigated several high-profile healthcare cases in state and federal courts, and we routinely counsel clients through a range of disputes and operational and transactional issues that don’t require courtroom intervention.

Behavioral Healthcare

The firm boasts a particular specialty in behavioral healthcare and works with mental health and substance abuse treatment (SUD) providers in all aspects of their businesses. We’re called upon to assist facilities with everything from day-to-day operations to professional defense, and most everything in between.

For instance, the firm handles commercial contracts, Management Services Agreements, leases, records requests, subpoenas and complaints. We also interact with law enforcement, city and county officials, homeowner’s associations, landlords and neighbors hostile to mental health and SUD treatment.

In addition, our lawyers have managed dozens of Special Investigations Unit and clinical audits, applying industry-specific knowledge to efficiently resolve payment delays and denials for both network and out-of-network providers. Likewise, we provide advice and counsel to these clients on marketing relationships, call centers, advertising strategies, online engagement, employee reimbursement, sales, sober living, client kickbacks, and laboratory relationships, all toward compliance with the Eliminating Kickbacks in Recovery Act (EKRA) and similar states laws. Providers also seek us out to develop strategies, guidelines, contracts, protocols, forms, policies and procedures to assist them in doing business legally in light of continually evolving changes in law and enforcement.

Add to the mix our capacity to develop and implement compliance programs, address the full spectrum of employment issues, and handle the corporate aspects of behavioral healthcare practice, and it’s no wonder why M&R is a leading law firm for those across the industry.

Areas of Expertise

Business Formation, Licensure & Certification
Day-to-Day Operations
Documentation & Reimbursement (including Special Investigations Unit and clinical audits)
Eliminating Kickbacks in Recovery Act (EKRA) Compliance
Employment Issues (including whistleblower, wage & hour, and discrimination actions and litigation avoidance)
Fraud & Abuse Compliance Program Development
High-Risk Events
Payor Relations and Reimbursement
Professional Defense
Transactional & Structural Matters (corporate practice of medicine)

Representative Matters

Represented the JOPAL Group in the $120 million transfer of physical assets (TPA) of Workmen’s Circle MultiCare Center, a 560-bed nursing facility, to a Delaware business trust — the first time the U.S. Department of Housing and Urban Development (HUD) has granted approval for the use of a Trust as a Borrower

Closed a leveraged buyout of a 499-bed nursing home in Manhattan (Dewitt Rehab) for $105 million, including a $90 million bridge to HUD from KeyBank. The property is located on the Upper East Side of Manhattan and has always been looked upon as the most significant site in Manhattan available for eventual redevelopment into condominiums M&R however counseled the client to operate it as a Nursing Home and not base their offer on a hope of condominium development and it is now the premier skilled nursing facility in New York State.

Represented both buyers and sellers in the acquisitions of mental health facilities across the country.

Led a team of lawyers in the roll up of medical service providers, including the purchase of an ambulatory service provider and an in-home care provider. Negotiated the terms of sale, the purchase agreement, organized a new holding company and assisted in the negotiation for new debt and equity for the combined firm.

M&R has been taking the lead on reorganizing the compensation of Surgeons in Ambulatory Surgery Centers to increase their profit share while successfully helping them navigate the rocks and shoals of the Anti-Kickback laws and the Ambulatory Surgery Safe Harbor attached to those law.

Represented a major manufacturer of medical devices in connection with $60 million revolving credit and term loan facilities.

Represented a large group of emergency physicians in litigation against an IPA to recover payment for services at physicians’ usual and customary rates. The Independent Physician Association (IPA) wrongly withheld several hundreds of thousands of dollars refusing to pay usual and customary rates for Current Procedural Terminology (CPT) codes as billed. M&R obtained a favorable settlement on the clients’ behalf, including payment of past amounts due, and structured agreed-upon contract rates going forward.

Successfully represented a physician group in an investigation by the federal government regarding the purchase of non-FDA approved drugs from foreign sources. M&R helped develop an interpretation of the applicable licensing statutes to prove that the client was misled into purchasing the drugs from an unlicensed source, which appeared to be properly licensed by more than one state, to sell the medications at issue.

Represented a provider of national healthcare services, as borrower, in a $250 million debtor-in-possession financing and a $515 million exit financing.

Successfully represented an emergency physician group being investigated by the Office of Inspector General for coding and billing irregularities, and other health care fraud as a result of a sealed qui tam suit filed under the False Claims Act. M&R negotiated with the Assistant U.S. Attorney to decrease the scope of the government subpoena, and retained experts to review the group’s billing and coding to corroborate the absence of fraud and abuse. We successfully defended the group, which resulted in the government choosing not to intervene in the qui tam suit, and the action being dismissed.

Counseled client in the $13 million refinance of Peninsula Nursing Home and Rehabilitation Facility in New York. This was a rather complicated matter in that a previous purchaser acquired a hospital and nursing home, broken up as two parcels, and kept the hospital while putting the nursing home, which was physically attached to the hospital, up for sale. Our client purchased the nursing home. During this process, we encountered several legal obstacles, not the least of which was an environmental issue related to construction debris and chemical traces at the nursing home site. M&R attorneys worked diligently with an environmental study company to revisit their report in light of new facts, thereby clearing any environmental roadblock and enabling the client to refinance.

Helped client close on the refinance of Middletown Park Manor Rehabilitation and Health Care Center, consisting of a $23,240,000 mortgage insured by the Department of Housing and Urban Development (HUD). This matter commenced in March 2010 with the purchase of the 240-bed facility by one of our long-time clients. After two refinances and a workout of the original purchase money financing, the project finally stabilized and was able to obtain a 35 year self-amortizing HUD mortgage with no personal guarantees and, most notably, a return of a substantial portion of the client’s original equity.

Represented detoxification facility in administrative action brought by the California Department of Health Care Services seeking revocation of client’s license.

Developed policies and procedures for substance abuse providers relating to marketing, referrals and payor relationships to ensure compliance with Federal and state regulations.

Represented addiction treatment facility operator in $100 million federal lawsuit against several treatment centers, testing labs, and individuals, alleging financial kickbacks, fraud and other violations. M&R filed a motion to dismiss the federal claims, which was ultimately granted by the Florida court, and with no remaining jurisdiction over the plaintiff’s state law claims, the case was dismissed. This represented a significant victory for our client and for the addiction treatment community.

Represented substance abuse treatment provider in national litigation involving alleged kickbacks from toxicology laboratory.

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