Our healthcare practice focuses on advising healthcare entities, including hospitals, health systems, medical foundations, IPAs, physician groups, and payors on a variety of business, regulatory and litigation issues. We have expertise in the complexities of managed healthcare, including Medicare and Medicaid reimbursement, the Affordable Care Act and EMTALA, as well California’s Knox-Keene Act, Health & Safety Code, Insurance Code and related regulations. Our attorneys are experienced with the workings of state agencies that regulate healthcare providers, insurance companies and healthcare service plans.
Our healthcare practice offers creative, strategic and practical advice to help our clients resolve legal disputes that invariably arise in today’s healthcare world. We understand the business of managed healthcare and the intricate relationships between hospitals, physicians, health plans, employers and government payors. Our attorneys have a record of successful results in resolving disputes favorably for our clients before litigation or arbitration is ever filed. Once formal dispute resolution is necessary, our attorneys focus on achieving excellent results through mediation, arbitration and litigation, while insuring that dispute strategies are in line with our clients’ business goals.
We have experience before state trial and appellate courts throughout California, the Eastern, Northern, Southern and Central Federal District Courts in California, the Ninth Circuit Court of Appeals, the American Arbitration Association (AAA), JAMS and American Health Lawyers Association Arbitration, among other venues.
Our attorneys have arbitrated numerous multi-million dollar disputes between hospitals, physicians and payors. We have resolved many disputes between providers and payors regarding managed care networking and reimbursement. Arbitration allows us to efficiently handle disputes of any size, even the largest and most complex matters. We have worked with many of the AAA and JAMS arbitrators experienced in healthcare, and we have a proven track record of favorable results for healthcare clients in the arbitration setting.
Boutin Jones Inc. also routinely advises employers in the healthcare field. Our firm’s attorneys provide advice on physician employment agreements, employee handbooks and arbitration agreements, and compensation and incentive bonus issues. We also handle compliance issues such as reasonable accommodation under the Americans with Disabilities Act and the California Fair Employment & Housing Act, wage and hour laws, leave statutes, harassment and discrimination, and employee performance, discipline and termination. Our attorneys also have significant experience in complex litigation in defense of employers in the healthcare field.
The firm’s lawyers have extensive experience resolving complex contractual disputes between hospitals, physicians and health plans. Our healthcare litigators have handled a broad range of lawsuits for healthcare entities, including actions involving government investigations, class actions, whistle blower/qui tam actions, payor/provider disputes and mergers.
Our lawyers have resolved many disputes between providers and payors related to ERISA plans, out-of-state payors, leased network PPOs, reasonableness of charges, coding for services, fee-for-service contract terms, capitated reimbursement, coordination of benefits, risk arrangements, hospital liens, uninsured/indigent policies and unfair competition.
Managed Care Contracting
Our healthcare attorneys have advised clients on complex contracts between providers and payors. Our experience in healthcare law and regulations coupled with our contract law experience provides us with the tools to advise clients in all phases of the contract negotiation process. Whether it is a quick amendment or a comprehensive renewal, we can provide legal advice and solutions to help achieve your contracting strategy and avoid future disputes.
Mergers and Acquisitions
The attorneys in our Corporate and Securities Group have extensive experience assisting and advising our clients with respect to mergers and acquisitions. We work closely with our clients throughout the acquisition process from strategy and structuring through due diligence, negotiation, closing and integration. We have represented public and private companies as well as small businesses, investors and individuals in a wide variety of transaction structures that includes traditional mergers, asset and stock transactions, ESOPs and management buy-outs. For example, in the healthcare market, we represented a large, Sacramento-based medical organization in connection with the acquisition of several professional practice groups.
The firm’s real estate lawyers have extensive experience in major, complex real estate acquisitions and dispositions, including the acquisition and disposition of medical buildings, medical complexes and related facilities. We handle all aspects of transactions, from structuring the entity and the transaction at the outset of the deal, through the closing. Additionally, we handle all aspects of commercial leasing, representing both landlords and tenants, including leases covering a wide variety of retail projects, office, industrial and medical office buildings. The firm’s real estate attorneys are also experienced in the documentation and negotiation of real property and mixed collateral secured loans.
The healthcare industry is heavily regulated. We have advised clients on compliance with many of the rules and regulations governing healthcare providers and payors. We have helped clients navigate the California state agencies that regulate healthcare entities. We have drafted policies for clients that enable them to comply with the many laws and regulations governing healthcare entities.
Boutin Jones Inc. served as counsel for a medical group in a dispute with an insurance company over the rates the group was entitled to be paid for cutting-edge medical services provided to the insured patients. The firm’s trial team prevailed by obtaining an arbitration award establishing the rate for services at the rate sought by the medical group. Shareholders Steve Boutin and Michael Chase were the primary Boutin Jones attorneys on this matter.
We have also served as counsel for a medical group in a dispute with a capitated health plan over the method of computing the capitated payments owed to the group under the parties’ agreement. The dispute arose after the passage of the federal Deficit Reduction Act of 2005 and the subsequent publication by Centers for Medicare and Medicaid Services (CMS) of Outpatient Prospective Payment System Relative Value Units (OPPS RVUs). The firm achieved a favorable settlement during the arbitration hearing which resulted in higher compensation to the group on a going-forward basis. Shareholders Michael Chase and Bob Swanson were the primary Boutin Jones attorneys on this matter.
Boutin Jones served as counsel for a medical group in a dispute with a capitated health plan over breaches of the group’s exclusivity rights. The firm’s trial team prevailed in arbitration proving that the parties’ contract entitled the group to add services which constituted “technical advances,” and recovered in excess of $250,000 in damages and attorney’s fees for the medical group. Shareholder Steve Boutin was the primary Boutin Jones attorney on this matter.
We have the largest and most experienced group of tax attorneys in the region. Our multi-disciplinary team of federal, state and local tax attorneys includes experts in income, estate and gift, sales and use, property, excise, employment and documentary transfer taxes. Our tax lawyers support our Healthcare Group by providing advice to our non-profit and for-profit healthcare clients on income tax, property tax, employment tax and sales and use tax matters, including advice regarding excess benefit transactions, private inurement, public benefit reporting, Forms 990 and 990-T, IRS Coordinated Examination Program audits and tax-exempt bond financing.