Health Care Quality

Hooper, Lundy & Bookman’s decades of experience and familiarity with policymakers are critical assets when our attorneys advise health care providers in all aspects of the health care quality initiatives emerging as keys both to both compliance and reimbursement.

We understand the increasingly complex issues and expanding definition of quality in the health care provider arena. Our attorneys are at the forefront of experience in the application of quality initiatives applied to providers at federal and state regulatory levels, as well as in the private sector. We have expertise in data reporting efforts, provider status, peer review, credentialing, contracting, compensation arrangements and new regulatory requirements and enforcement actions as they all become more dependent on quality parameters.

From a compliance perspective, we have unparalleled experience in understanding, translating, advising and defending hospitals, health systems, long-term care facilities, medical groups, surgery centers and other providers in developing compliance plans; handling investigations and audits, and responding to and defending enforcement actions.

From a reimbursement perspective, we are nationally known for our successful representation of providers in Medicare, Medicaid and private payor reimbursement issues. A number of our attorneys are licensed health care practitioners in their own right, and have a wealth of hands-on clinical experience, which brings an added dimension to advising our clients on a wide range of quality issues, such as adverse events.

Our healthcare business and regulatory attorneys are deeply involved with clients in all aspects of emerging pay-for-performance, gain-sharing and clinical co-management agreement transactions and issues.

Our litigators frequently represent health care providers in all aspects of litigation involving payment disputes from Medicare, Medicaid and private payors. This is becoming increasingly important as private payors adopt quality parameters for reimbursement.

The issues we have advised our clients include:

Quality initiatives of The American Recovery and Reinvestment Act
The Patient Safety Act and other adverse event related issues
Medicare and Medicaid Pay for Performance Initiatives
Patient Safety Organizations
Private payor contracting
Structuring Pay for Performance Initiatives.

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