Health Care
GRSM's national Health Care practice group represents and advises general and specialty hospitals, nursing homes, home health agencies, assisted living facilities, continuing care retirement communities, acute psychiatric hospitals, residential behavioral health facilities, and other health care providers. The group's experience includes malpractice, elder abuse, contract, class action, fraud, compliance, reimbursement, False Claims Act, and HIPAA matters. GRSM lawyers have notable experience in successfully defending physicians in medical malpractice lawsuits, state licensing, grievance and disciplinary proceedings.
In addition to litigation experience in State and Federal courts, GRSM Health Care attorneys have a comprehensive understanding of the day-to-day business issues facing medical and health care professionals. We represent clients in regulatory compliance issues and citation appeals, the development of policies and procedures, risk management programs, business transactions and employment law matters. Our experience includes state licensing actions, employment counseling, employee termination and discipline, discrimination and harassment claims, wage and hour issues, development and review of employee handbooks, and business matters such as medical practice formation and dissolution, facility purchases, and sales and leases.
Labor and Employment
Managed Care Litigation
Health Care Professional Liability
Business/Contracts Litigation
Commercial Agreements and Transactions
Licensing and Regulatory
Unique Qualifications
Labor and Employment
GRSM represents assisted living, skilled nursing and Alzheimer care facilities, as well as health care clinics, in all areas of labor and employment law, such as advising on wage and hour issues, personnel policies, including those related to 12-hour shifts, to defending against harassment, discrimination and retaliation claims.
Our representation of healthcare providers in employment counseling and litigation matters includes extensive experience drafting and litigating non-competition agreements for doctors, practice groups and IPAs. We have also successfully tried many employment cases to defense verdicts on behalf of medical groups.
The employment litigation we handle on behalf of healthcare providers is often combined with regulatory issues as plaintiffs frequently claim they were discharged as a result of complaining about healthcare regulatory violations.
Back to Top
Managed Care Litigation
GRSM's Managed Care Litigation lawyers leverage the combination of specialty experience in health care contract litigation with extensive insurance coverage experience. We have resolved many contract claims brought by providers against payors, including insurers, HMOs, and self-insured plans. We have handled claims ranging from benefit entitlement disputes and contract terms, to appropriate treatments and medical necessity determinations, to unbundling and usual and customary charges. Our Managed Care Litigation team has a broad range of experience representing health care providers and health, life and disability insurance carriers in high profile litigation in state and federal courts throughout the U.S.
- Claims for authorization and reimbursement of health benefits which are denied as experimental, investigational or not medically necessary
- Fraudulent claims by health care providers seeking reimbursement for services either not rendered, not medically necessary, or in excess of usual and customary fees
- Defense of claims by health care providers under contracts with payors, including insurers, health care service plans, and employers
- Disputes among payors regarding applicable plan provisions and determining primary versus secondary payor
- Disputes regarding application of stop-loss provisions, interpretation of maternity benefits, and proper case rates
Back to Top
Health Care Professional Liability
The Health Care Professional Liability Defense Group is devoted to the defense of health care providers, both insured and self-insured. The team has successfully defended cases at trial, arbitration and on appeal against health maintenance organizations, hospitals, doctors, nurses, surgical clinics, long term care facilities and other providers. We also have experience with State Medical Board and hospital administrative proceedings. Examples of our experience include the following:
- Unanimous jury verdict in federal court for medical malpractice case against surgeon for complications from enterotomy in laparoscopic inguinal hernia surgery.
- Summary judgment in federal court in wrongful death medical malpractice action against hospital with allegations of patient dumping and EMTALA violations.
- Summary judgment for pain management physician in spinal meningitis case.
- Dismissal of wrongful death case against hospital for failed cardiac catherization procedure.
- Dismissal of all claims against physician for failure to diagnose cervical cancer.
- Summary judgment for hospital for wrongful death of infant, including punitive damages claims against obstetrical nurse employees.
- Dismissal of all claims, including punitive damages, in wrongful death case against internist for failure to perform peritoneal lavage and investigate source of internal hemorrhage.
- Dismissal of all claims against anesthesiology group for wrongful death of child.
Back to Top
Business/Contracts Litigation
Our Health Care practice lawyers regularly handle a wide scope of commercial disputes through trial, arbitration, and mediation. We have handled issues involving consumer protection/deceptive trade; unfair competition/antitrust in mergers and acquisitions; vendor contracting disputes; and Class Actions against healthcare providers relating to alleged overbilling, understaffing and other fraudulent practices. Examples include:
- Dispute between two Northern California medical providers concerning managed health care contracts, and related ongoing governance provisions and agreements.
- Representation of individual doctors, practice groups in a wide variety of specialties, and IPAs in litigating non competition agreements.
- Representation of an ownership group consisting of doctors in a dispute involving the control of a series of MRI centers.
- Representation of a variety of Scripps Health system entities in various commercial disputes, business litigation and bankruptcy related matters.
- Representation of a health care consulting company in a multimillion dollar unfair competition lawsuit involving competing urology practice groups.
- Representation of a national diagnostic laboratory in a Qui Tam action regarding an alleged dual pricing scheme wherein Medicare is charged more than private physicians who order lab work.
Back to Top
Commercial Agreements and Transactions
Our Business Transactions team is closely integrated with our Health Care practice to provide strategic support in a wide range of business transactions that must take into account considerations that are unique to the health care field, including privacy, reimbursement, antitrust, tax, and a myriad of local, state and federal regulations. Our experience includes transactions involving nursing homes, hospitals, physician groups, health plans, ancillary service providers, assisted-living facilities, pharmacies and pharmacy benefit management companies, ambulatory surgery centers, independent diagnostic testing facilities, provider networks, and medical device manufacturers.
We advise on: enterprise structure and governance; mergers, acquisitions, divestitures and affiliation arrangements; business and corporate reorganizations; and services and practice management joint ventures. Our experience in deal structures, term negotiation and due diligence includes the following types of business transactions in the nonprofit and for-profit healthcare arena.
- Represent health care providers in negotiations with government agencies
- Represent buyers and sellers in mergers and acquisitions
- Provide advice on joint ventures between physicians and other entities
- Draft partnership agreements for physician groups
- Represent health care providers in the purchase/sale of practices
- A broad range of business transactions involving licensing, e-commerce, and privacy, including issues unique to tele-medicine related transactions
- ER provider contracting agreements and relationships.
Back to Top
Licensing and Regulatory
GRSM has extensive experience advising and representing a broad array of health care providers on regulatory issues and navigating licensure and certification requirements. We routinely advise health care clients on regulatory compliance at both the state and federal level, including the Medicare and Medicaid requirements of participation. We advise health care providers on how to comply with numerous regulatory requirements, including admission and discharge of residents, release of records, reporting requirements, reimbursement regulations, and how to avoid violations of fraud and abuse laws and regulations. Our health care team also provides advice on HIPAA and compliance with other health privacy requirements.
The firm's Health Care attorneys also assist in challenging adverse survey findings. We have drafted plans of correction and represented providers at informal dispute resolution meetings as well as litigating against state agencies. Examples of our experience include:
- Assist with obtaining licensure and certification
- Represent providers before state licensing boards on disciplinary matters
- Assist providers in challenging adverse survey findings
- Defend providers in Medicare and Medicaid hearings and appeals before the Provider Reimbursement Review Board, Medicare Office of Hearings and Appeals, and state administrative agencies
- Represent providers in negotiations and litigation with Medicare fiscal intermediaries regarding Medicare overpayments
- Represent health care providers in False Claims Act litigation
- Provide advice on HIPAA and compliance with other health privacy requirements
- Develop compliance plans and policies and employee training programs
- Advise on risk management issues
- Assist with responses to government investigations, including negotiations with the government
- Counsel clients on how to avoid violations of fraud and abuse laws and regulations
Back to Top
Unique Qualifications
The strength of GRSM's Health Care Practice is based on the depth of the group's knowledge of the complete range of legal, medical, regulatory and business considerations that are specific to the health care profession. At GRSM, our Health Care group includes lawyers who also have health care related professional degrees, first-hand experience working in health care provider settings, and leadership positions in various health care related trade associations, legal advisory committees and government agencies. Examples of the unique qualifications of GRSM's Health Care Practice include the following.
- "Super Lawyers®": GRSM's Health Care Group includes lawyers who have received the Super Lawyers® distinction in the fields of Health Care and/or Professional Liability Defense in the annual survey conducted by Law & Politics magazine.
- Health Care Degrees: GRSM's Health Care Group includes three lawyers with Bachelor of Science degrees in Nursing, as well as lawyers with a Bachelor of Science degree in Microbiology, a Master of Health Services Administration, and a Master of Public Health.
- Practical Experience in Health Care Provider Settings: Prior to joining GRSM, many of our Health Care Group lawyers worked in various segments of the health care profession including a registered nurse in an acute care setting, an assisted living facility director and skilled nursing and rehabilitation facility administrator, a corpsman in the U.S. Navy working in the medical/surgical intensive care unit, in-house counsel for the San Diego Psychological Association including extensive work with psychiatric acute care hospitals, long term care and residential care facilities, and an Assistant General Counsel for the Texas Department of Human Services.
- Leadership in Trade Associations: GRSM Health Care Group lawyers are members of the American Health Lawyers Association, American Health Care Association, Aging Services of California, California Association of Health Facilities, American Society of Hospital Risk Managers, California Society of Hospital Risk Managers, California Medical Legal Committee, Texas Association for Home Care, San Diego Psych-Law Society, Federation of Defense and Corporate Counsel, Defense Research Institute, American Board of Trial Advocates, and the Faculty of Federal Advocates.