We have unrivaled experience representing physicians in today’s increasingly complex healthcare industry. For more than 25 years Nelson Hardiman attorneys have advised medical groups, physician organizations, and individual practitioners on the legal intricacies of medical practice. We help our clients grow their medical practices provide the highest level of patient care and achieve their professional goals by structuring healthcare businesses to comply with stringent regulatory and licensing requirements and minimize risk across the board.

Nelson Hardiman lawyers represent doctors in licensing, credentialing and reimbursement proceedings and advise large managed care physician organizations. We know the regulatory enforcement issues of physician practice and have the legal chops to craft effective compliance solutions. In the rapidly evolving world of modern medicine, we navigate the operational complications of value-based care and the nuanced complexities of physician practices and medical staffs. We proactively tackle healthcare issues and help drive next generation healthcare concepts to realization for our physician clients. Thought leaders committed to the future of the healthcare industry we are consummate problem-solvers for physicians’ regulatory, transactional, and litigation needs.

Nelson Hardiman represents physicians who specialize in aesthetic medicine. We are known for our deep experience and successful track record in accomplishing the goals of our aesthetic medicine providers and medical spa clients. We counsel on business issues, protect against regulatory investigations, and defend high stakes litigation.

Our attorneys understand the legal issues impacting aesthetic medicine providers and handle the most sensitive challenges. We establish compliance programs in response to government investigations and defend against Medical Board accusations. And because California’s ramped-up enforcement measures focus on illegal ownership structures and regulatory concerns, we thoroughly review the corporate and operational structures of our aesthetic medicine provider clients to ensure compliance with the state’s regulatory environment. Whatever the challenge, Nelson Hardiman has the experience and resources to resolve the problems, issues and concerns of aesthetic medicine providers.

Our Work Includes:

  • Audit Risk Assessment Performed an audit risk assessment on Stark and Anti-Kickback Statute compliance for a MediSpa contracting for aesthetic medicine services.
  • Compliance Advised a prominent anti-aging and integrative healthcare provider on standard of care, informed consent and patient agreements, marketing claims, and HIPAA compliance.
  • Corporate Structure Advised on corporate entity formation, together with governance documents to support regular business operations, financing, and merger for an aesthetic medicine specialty business.
  • Licensure Handled related license/credentialing appeals for a provider of surgical and non-surgical cosmetic procedures.
  • Litigation Defended business and employment litigation and partnership disputes for a non-invasive aesthetic medicine practice with multiple locations in Southern California.
  • Management Companies Set-up management companies to assist with management and financing for MediSpas and related entities.
  • Medical Board Investigation Defended Medical Board investigation for a MediSpa company concerning allegations of insufficient physician supervision of aesthetic medicine procedures.
  • HIPAA and Information Security Counseled several consumer medicine providers on HIPAA and state health information privacy laws and development of privacy compliance programs.

Nelson Hardiman accomplishes the goals of primary care physicians facing new challenges from the evolving medical, technological and regulatory landscape. The resurgence of managed care, accelerated by the Affordable Care Act (ACA) drives the increased migration of physicians out of private practice into managed-care, hospital-affiliated independent physician associations (IPAs), creating new operational and alignment issues for physicians and setting the stage for new models of delivering healthcare services such as concierge practices and telemedicine.

As primary care physicians service a growing patient population and explore new healthcare delivery models, we help navigate complex legal issues such as the Anti-kickback and Stark laws, HIPAA privacy compliance, and California’s ban on the corporate practice of medicine. Whether you want to set up a compliant IPA business model, negotiate a managed care contract, or are facing exclusion from a health plan’s “narrow network,” we represent primary care physicians in business matters and high-stakes litigation where it counts. Whatever the challenge, Nelson Hardiman has the experience and resources to resolve the problems facing our IPA clients.

Our Work Includes:

  • Corporate Practice of Medicine Advised on corporate practice of medicine requirements in structuring business and financial relationships between physicians, entrepreneurs, and investors.
  • Employment Drafted employment contracts, employee handbooks and independent contractor agreements for several physician practices.
  • HIPAA and State Patient Data Privacy and Security Requirements Advised a national physician specialty organization in developing a HIPAA-compliant patient data registry providing outcomes measurement and quality improvement.
  • Medicare Overpayment Achieved a $3.1 million (from $3.2 million to $75,000) reduction in a Medicare over-payment determination against a physician group in a contested hearing against recovery audit contractor.
  • Merger & Acquisition Represented a large dermatology practice, including a dermatopathology lab, in a $15 million acquisition. The complex transaction required a complicated series of financial tranches structured to meet tax and regulatory requirements.
  • Partnership Dispute Successfully mediated a partnership dispute involving an orthopedic practice of physicians and chiropractors.
  • Stark and Anti-Kickback Statute Advised primary care physician groups on compliance issues.
  • Telehealth Compliance Advised a national telehealth provider on multi-state licensing, compliance, reimbursement, patient privacy, and standard of care issues.
  • Unfair Competition Obtained dismissal on a motion for summary judgment involving medical partnership that falsely accused a competing surgery center of stealing physicians and providing unlawful payments in return.

Nelson Hardiman provides pro-active counsel, independent of in-house counsel, to consult on peer review matters, represent medical staff in hearings, conduct interviews and discovery before litigation, and provide legal representation of medical staff during litigation and on appeal.

We work with facilities across California to ensure compliance with all aspects of the peer review and credentialing process. Nelson Hardiman is a go-to firm in the medical staff arena.

Our Medical Staff Peer Review Team:

Sara Hersh

Miriam “Sarvnaz” Mackin
Attorney at Law

Our Work Includes:

  • University Healthcare System  Revised and redesigned medical staff bylaws, policies, procedures of several academic medical centers to comply with statutory requirements and best practices; reconstituted committees and accompanying policies for physician health and professional conduct committees of the medical staff.
  • Peer Review Hearing and Appeal A general surgeon on staff at a community-based hospital requested a hearing based upon a suspension of his medical staff privileges due to his treatment in four cases, all of which were reviewed and deemed to constitute practice below the standard of care and which posed an imminent danger to patients and potential patients. The hearing consisted of testimony by physician witnesses and experts on both sides. At the conclusion of the multi-year hearing, the judicial review panel decided that the suspension was reasonable and warranted in light of the facts. Upon appellate review by the hospital’s governing board, the decision was affirmed.
  • Peer Review Hearing and Appeal Represented the Medical Staff of an academic medical center in a peer review hearing before a hearing panel and hearing officer. The subject physician-directed his residents to access medical records of a patient the physician was not treating and subsequently brought to the Med Center an outside unauthorized physician to look at the records and render an opinion as to the cause of the patient’s medical condition. The Med Staff charged the physician with violating HIPAA,  Med Center policies, and abusing his authority over residents for the purposes of gaining improper access to the patient’s records for himself and enabling an outside physician to access medical records without the patient’s consent or other proper purpose. The physician maintained he was authorized to engage in these activities in his role as a teaching professor and therefore had the authority to bring in an outside physician to “investigate” an event, as part of the physician’s self-organized investigation team. The panel unanimously found in favor of the Med Staff and against the physician on all charges.

Strong regulatory support and a keen grasp of business are the keys to success in any physician practice. Nelson Hardiman helps physician subspecialists manage the constantly changing regulatory climate and achieve their financial and market objectives in the rapidly evolving healthcare industry.

We are problem solvers. Our attorneys are authorities on healthcare fraud and abuse, with a national reputation for industry-wide business expertise. We have developed key resources to facilitate compliance and provide support for the realignment underway in the healthcare industry. The key to our success is our keen insight into the changing regulatory landscape and emerging industry trends. Focused on regulatory and reimbursement challenges and strategy, clinical safety, and data security, we provide dynamic, cutting-edge legal services to physicians across a wide range of business, regulatory, and strategic challenges.

Our Work Includes:

  • Billing Dispute Prevented litigation between physicians and billing company over the denial of claims by the Centers for Medicare and Medicaid (CMS).
  • Digital Healthcare Referral Services Analyzed website referral services and counseled chiropractic client on potential fee-splitting, anti-kickback, and other regulatory issues.
  • Factoring Counseled and documented various factoring and ABL lines for medical groups.
  • False Claims Act Undermined Relator’s false claims act theory and demonstrated that our physician client was not involved in an alleged conspiracy to admit psychiatric patients using California’s involuntary procedure.
  • Healthcare Fraud Counseled a physician in a dispute with a healthcare district in Riverside County in which the district sued for alleged fraud and fee-splitting.
  • Partnership Dispute Successfully mediated a partnership dispute involving an orthopedic practice of physicians and chiropractors.
  • Stark Law and Anti-Kickback Statute Compliance Obtained dismissal from civil conspiracy complaint and cleared client as a potential target of a criminal investigation of a large-scale workers’ compensation scheme involving over 70 parties, including California hospitals, medical device companies, pharmacies, marketers and physicians.
  • Trade Secret Dispute Defended a physician in a misappropriation of trade secrets and interference with contract case by another physician involving disputes over access to patient lists.

Leaders in healthcare innovation, Nelson Hardiman provides deep insights and strategic counsel on the new era of value-based care (VBC). Rapidly supplanting the waning “fee-for-service” era of volume-based reimbursement, we help integrative health systems manage risk and optimize VBC models in their practices.

We advise on risk management issues of data sharing and usage, reimbursement structures and cost controls, technological initiatives to facilitate patient engagement, and effective practice integration. Nelson Hardiman helps our integrative health systems clients identify risk and optimize value to efficiently realign and thrive in the brave new world of value-based healthcare.

Our Work Includes:

  • Business Transactions Advised on operational matters including corporate reorganizations, integrated health systems.
  • Complex Business Planning and Negotiation Served as in-house counsel for several nonprofit integrated health systems advising on business planning and structuring, contract negotiations, and the broadest range of reimbursement and regulatory compliance and strategy.
  • False Claims Act Civil fraud experience includes defending integrated health systems in complex federal and state FCA actions involving claims for allegedly non-reimbursable, unnecessary or inflated services and costs.
  • Healthcare Factoring Structured factoring transaction for six healthcare providers and three investment firms involving $20 million in workers’ compensation accounts receivable in response to changes brought forth by California Senate Bill 1160.
  • HIPAA Compliance Advised multiple integrated health systems on HIPAA privacy and data security breaches; implemented HIPAA compliance programs for numerous entities, including developing a patient data registry providing outcomes measurement and quality improvement.
  • Medicare Compliance Advised digital health company on compliance and risk management strategy in servicing Medicare beneficiaries and contracting with Medicare and in-network healthcare providers.
  • Stark/Anti-kickback Statute Negotiated and implemented a corporate integrity agreement on behalf of an integrated health system following federal investigation of Stark/Anti-Kickback Statute violations.