M&R attorneys are intimately familiar with the business, tax and legal strategies for structuring corporate and real estate ownership, investment and employment for Ambulatory Surgery Centers (ASC). We offer cutting-edge advice to business and physician investors to help them successfully navigate the evolving regulatory environment. Our attorneys counsel owners and practitioners on ways to increase profitability and owner accountability while remaining compliant with applicable law, including the federal Anti-Kickback Statute, the federal physician self-referral prohibition (Stark Law), Affordable Care Act (ACA) and related state laws.

Our ASC practice encompasses a broad range of services offering an integrated team approach to business goals. We represent both single-specialty and multi-specialty centers in matters including: corporate formation and governance; contracts; financing; mergers and acquisitions; shareholder and operating agreements; real estate transactions; tax structuring; labor and employment; service line outsourcing; profit allocation structuring; HIPAA and corporate compliance.

Developing and operating a successful ASC involves a number of complex and interdependent legal issues, which must be reconciled with business goals, ranging from state licensure requirements to real estate acquisitions to owner incentives. M&R attorneys offer creative solutions to regulatory and business challenges, providing strategic advice focused on specific issues or goals, with the participation of specialized counsel when needed. With over 100 years of combined experience in the health care industry, M&R attorneys work across disciplines to achieve unparalleled results for their clients.

M&R is actively involved in the Ambulatory Surgery Center Association (ASCA), and often presents to industry stakeholders.

We are well-versed in all the various state and federal regulatory requirements regarding ancillary service providers. Our Health Care attorneys represent clients across the wide gamut of ancillary services including those of a diagnostic, therapeutic and custodial nature. We routinely represent suppliers of laboratory tests, pharmacies, home infusion and hospice care providers, skilled nursing facilities, ambulatory surgical centers and radiologists, among others.

Senior and assisted living facilities are experiencing challenges due to industry growth, regulatory pressure, and increased consumer demand. Drawing from M&R’s in-depth experience across multiple practice areas, our Health Care Department provides full-service representation to senior housing and assisted living facilities, helping providers thrive in the changing marketplace. We work with a full spectrum of stakeholders, including: developers, banks, not-for-profits, and facility owners.

Clients rely on M&R to provide advice on financing, regulatory compliance, labor issues, and general business matters. We have expertise in supporting complex financial transactions, including the purchase and sale of assisted living and senior housing businesses. We assist clients in deal structuring, performing due diligence and preparing and negotiating the necessary financing documentation. Our team has worked on sophisticated and high-stakes financing in the industry, and offers particular expertise with regard to the Immigrant Investor Program (EB-5) and Medicaid reimbursement matters. 

The M&R team understands the various operational hurdles that must be cleared in order to successfully manage an assisted living or senior housing facility. We advise clients on day-to-day business issues, as well as key documentation such as management, admission, resident and operating agreements. Our team also counsels on a variety of employment law issues, ranging from employee compensation and benefits to discrimination complaints to non-competition agreements.

We assist medical professionals in determining the optimal business structure for their organizations and customize ownership agreements. Because health care is highly regulated, our attorneys regularly advise clients on state licensing law and federal requirements, and provide representation before state licensing boards. We counsel national and regional providers on all certification and licensure matters.

We navigate clients including hospitals, skilled nursing facilities, urgent care facilities, ambulatory surgery centers, ambulance companies, assisted care facilities, ancillary service providers, physician groups, medical groups, group purchasing entities and management companies through sophisticated financial transactions. We have particular expertise with medical group formation. Further, we have handled trade finance facilities, commercial paper, conduits, various securitization vehicles, asset-based financing, leasing transactions, loans, revolvers, turn around projects, buyouts, compliance, formation and licensing for a myriad of medical facilities. We draft and negotiate lease agreements for all our health care provider clients. We perform due diligence and counsel clients on the nuances of leasing medical facilities.

Health care fraud and abuse laws can be complex and tricky. We design and implement compliance programs that mitigate the potential for violating Stark Law, the False Claims Act, the Federal Anti-Kickback Statute, and other state laws and federal health care regulations. Further, we audit and conduct internal investigations to ensure these programs work effectively.

We ensure our clients are in full compliance with the Health Insurance Portability and Accountability Act (HIPPA), which strives to protect patient privacy and security. Violating HIPAA can lead to government investigations, civil and criminal liability, and financial devastation. Our attorneys stay abreast of increased enforcements, modifications and rule changes to this complex area of the law.

We advise and litigate on behalf of providers and owners on the nuances of California’s constantly evolving Medical Assistance Program.

We routinely structure, negotiate and close complex M&A transactions involving health care entities and facilities. Acquiring or selling a medical facility requires extensive due diligence in complying with regulatory requirements and adherence to the proper transfer of Medicare billing privileges and certificates of need. Further, Stark and other fraud and abuse laws often come into play. Our Health Care attorneys navigate clients through these complex transactions, advising on numerous sales and acquisitions of hospitals, ambulatory surgery centers, nursing homes, assisted living facilities, urgent care clinics and other medical facilities. 

Partnership disputes can be caused by many factors, such as financial disagreements, falling revenue, succession issues, corporate governance issues and conflicts in vision over the business’s strategic direction. We work on behalf of our health care clients to efficiently resolve partner disputes and are tenacious litigators when amicable resolutions are not possible. 

We have a proven track record of defending physicians before various medical and dental boards in administrative proceedings, as well as the Board of Pharmacy.

The economics of reimbursement impacts every aspect of a health care business. We are renowned authorities in representing national and regional providers in billing disputes and obtaining maximum reimbursements. We understand that health care regulations are constantly evolving and provide sophisticated counseling on reimbursement issues arising under Medicare, Medicaid and other governmental programs. We advise and assist clients in mitigating False Claims Act risks. Our Health Care attorneys guide a wide array of health care providers through complex issues relating to every area of billing, coding and reimbursement. We also advise hospitals on their transfer and admission procedures, and have been successful in securing reimbursements on their behalf.

The M&R team applies our knowledge of the skilled nursing facility landscape to provide industry-focused expertise that caters to our clients’ needs. Our team regularly handles the most difficult and complexly structured transactions that require out-of-the-box thinking, in addition to the day-to-day business matters of skilled nursing facilities. And when litigation becomes necessary, we fiercely advocate on behalf of our clients, particularly in reimbursement matters and fraud and abuse defense, where our insight into the inner workings of the skilled nursing industry affords us a distinct edge.

By staying up-to-date on evolving laws and regulations affecting skilled nursing facilities, our team solves compliance problems and helps clients successfully navigate audits and investigations. We also train clients on compliance and regulatory issues, so that they may avoid future pitfalls. We conduct thorough investigations to help avoid audits and, when necessary, we have successfully defended audits. The M&R team routinely works with buyers, sellers, banks and operators on skilled nursing facility financing deals for acquisitions, renovations and construction. Our attorneys assist with loan preparations, equity securitization transactions, equity funds and partnership syndications of facilities. 

We also help skilled nursing facilities with licensing issues, collection issues, admission agreements, resident handbooks, and policies and procedures. Our team provides advice and structuring under the Bundled Payments for Care Improvement (BPCI) initiative, Medicare Access and CHIP Reauthorization Act (MACRA) and Medicaid Long-Term Care (MLTC) with an ability to help navigate the waters into shared risk and shared savings.

One of our partners is on the Board of Directors of a nursing home based in New York, and serves as chair of its Audit and Compliance Committee.

We represent a variety of substance abuse treatment providers and sober living facilities in ensuring state and federal regulatory compliance, resolving payment disputes, assisting with payer audits, determining medical necessity, and by advising concerning marketing arrangements and industry referrals. In addition, our Health Care attorneys regularly counsel facility owner/operators and related laboratories regarding fraud and abuse compliance policies and procedures. We regularly represent providers at administrative hearings and before state and federal courts throughout the country, helping our clients resolve complex disputes and protecting their underlying business interests.

M&R attorneys are immersed in the rapidly growing Urgent Care sector. We regularly speak on pressing legal issues at urgent care conferences and report on important matters in trade publications, as well as through Client Alerts and the M&R Heath Care Blog. Our deep industry knowledge gives M&R an advantage in counseling on formation, state licensure, reimbursement considerations, and the regulatory requirements of the Emergency Medical Treatment & Labor Act (EMTALA). We represent both physicians and private investors on a national scale in the establishment, and sale, of urgent care centers—both through mergers and their affiliation with other healthcare facilities. Our attorneys counsel urgent care centers on employment matters, contracting, fraud and abuse, and risk management. In addition, we strategically and aggressively litigate cases when disputes arise.