Chris Puri has established himself as a nationally recognized professional in the area of long term care and senior housing. As a leader in both the provider community and within the ranks of long term care attorneys, Chris’s industry experience and depth of knowledge in long term care allows him to provide clients with a comprehensive, full-service practice capable of handling the full array of legal issues for those providers. He takes an active role in both helping to develop long term care policy at both the state and national levels, and educate clients and attorneys alike in those areas.
During his tenure with the Tennessee Health Care Association (THCA), Chris provided counsel to the association and its members in the areas of survey/certification and licensure, Medicare and Medicaid reimbursement and compliance, expansion and development of community-based services, risk management and tort litigation, as well as other general areas of healthcare and long term care law. In addition to his extensive regulatory counseling, Chris represented the association in its regulatory efforts before state regulatory bodies and has drafted and lobbied for many of Tennessee's long term care laws. Prior to joining the firm, Chris served for seven years as legal counsel for THCA, the state trade association representing approximately 90 percent of Tennessee nursing homes.
As a leader in long term care, he currently serves as a member of the American Health Care Association's Legal Subcommittee, and participates in both its Medicaid Reform and Survey Reform Task Forces. He is a Planning Committee member for the American Health Law Association (AHLA) Long Term Care and the Law program, and is past chair of its Long Term Care Practice Group, and is on the editorial board of Eli Research's Long Term Care Survey Alert. Chris is a regular speaker and author for national and state audiences, including AHLA, the Tennessee Bar Association, and the American and Tennessee Health Care Associations. He is a graduate of the Tennessee Bar Law Association's Leaders Program in 2006. Chris participates in both the Tennessee and Nashville Bar Associations.
Listed in The Best Lawyers in America®, Health Care Law, 2021-2022 Listed in Mid-South Super Lawyers, "Rising Star," Health Care, 2009 Eli Publishing Long Term Survey Alert, Editorial Board Member Tennessee Bar Association, Leadership Law Program (2006) Outside General Counsel to Tennessee Health Care Association and Individual Providers Chris serves as outside general and regulatory counsel to a number of clients, including individual providers as well as the Tennessee Health Care Association, the state's largest trade association of long term care providers. Representation of National Hospice Provider in Qui Tam Lawsuits As part of national multi-law firm team, represented a national hospice provider in the investigation and defense of several qui tam lawsuits related to potential violations of the federal False Claims Act, related to the eligibility issues for long-stay hospice patients. Representation of National Provider in Appealing Medicare Claim Denials Represented a national therapy provider and nursing home client in the appeal of numerous denials of Medicare claims through the multi-level Medicare appeals process. Representation of Hospice Provider in Hospice Cap Appeal Represented hospice provider in the appeal of improper calculation of hospice cap limitations and challenge to the recoupment of Medicare reimbursement from the client. Case involved a legal challenge to the hospice cap methodology as articulated by CMS. Amicus Brief for American Health Care Association On behalf of the American Health Care Association, a national long term care association, drafted an amicus brief in the West Virginia Supreme Court arguing for the application of the Federal Arbitration Act to defeat state specific legislation preventing nursing homes from using pre-dispute arbitration agreements. (Marchio v. Clarksburg Nursing & Rehabilitation Center, Inc.) Tennessee Health Management Refinance of Portfolio of Skilled Nursing Facilities Represented Borrower in refinance of portfolio of 13 skilled nursing facilities with FHA insured mortgages under Section 232/223f. Regulatory and operations guidance Provided regulatory and operations guidance to the client, a large nursing home provider and an affiliated long term care pharmacy company, in the implementation of the Medicare Part D program in their facilities. Guidance and advice included interpretation of various federal laws and regulations and advice to minimize the impact of non-covered medications in the company's facilities. Sales, mergers, financings and reorganizations of national and regional long term care providers Acted as local counsel to assist with real estate and regulatory matters in connection with sales, mergers, financings and reorganizations of numerous national and regional long term care and senior housing providers. Transfer and discharge hearing Represented client in a transfer and discharge hearing. Facility staff was presented with significant problems created by the disruptive behavior of a patient in the facility. Worked with the facility and staff to evaluate the situation, and represented the facility in an administrative proceeding before TennCare. Situation was resolved through a negotiated settlement that included a behavior agreement, which resulted in the significant improvement in the behavior of the patient. Life safety regulatory issues Represented client in the successful challenge of various life safety regulatory issues incorrectly cited by the Tennessee Department of Health, resulting in a several thousand-dollar savings to the client who would have otherwise had to undertake major replacement of certain fixtures in their facilities. Conley v. Life Care Center of America, 236 S.W. 3d 713 (Tenn. Ct. App. 2007) Successfully argued for amicus curiae, Tennessee Health Care Association, that plaintiff’s claims were properly brought under the Tennessee Medical Malpractice Act, precluding alternative claims under the Tennessee Adult Protection Act (TAPA). Marmet Health Care Ctr., Inc. v. Brown, No. 11-391, 56 U.S. ____ (2012) Achieved a significant policy victory for skilled nursing facility providers in a closely followed decision in the United States Supreme Court. The Court summarily reversed West Virginia’s prohibition against pre-dispute agreements to arbitrate personal-injury or wrongful-death claims against nursing homes. The decision makes clear nationwide that incorporating pre-dispute arbitration agreements into admission agreements is both fair, appropriate and legally defensible. Along with the Bradley appellate team, Mr. Puri represented the amicus curiae interests of the American Health Care Association both at the state supreme court and U.S. Supreme Court levels. Owens v. National Health Corp., 263 S.W.3d 876 (Tenn. 2007) Successfully argued for amicus curiae, Tennessee Health Care Association, in defending the right of long term care facilities in Tennessee to use pre-dispute binding arbitration agreements. Arbitration agreement and corporate-wide ADR program Drafted and designed an arbitration agreement and corporate-wide ADR program for the client, which included multi-media elements to increase the acceptance and enforceability of the arbitration option. Corporate-wide training also was provided during the rollout of the new agreements. Corporate-wide admissions and arbitration program Drafted and designed a new corporate-wide admissions and arbitration program for the client. Admissions agreements and program include the ability for the facility to reduce admissions time and improve communication with families at the time of admission. Corporate-wide training also was provided during the rollout of the new agreements. False Claims Act Claims Against A Long Term Care Administrator Represented the administrator of a skilled nursing facility and successfully negotiated settlement claims against him brought by federal and state governments under their respective False Claims Act statutes prior to prosecution of the individual. Hospice Internal Investigation Represented a large national hospice company in the internal investigation and audit of billings issues relating to potential violations of civil and criminal fraud, false claims, anti-kickback, physician self-referral, and related federal and state healthcare fraud and abuse laws. Activities included employee interviews and rendering legal opinions on self-disclosure and repayment obligations under Medicare and Medicaid laws. Long Term Care Company Admissions/Arbitration Program Drafted and designed a new corporate-wide admissions and arbitration program for the client. Admissions agreements and program include the ability for the facility to reduce admissions time and improve communication with families at the time of admission. Corporate-wide training also was provided during the rollout of the new agreements. Long Term Care Facility Compliance Represented client in the successful challenge of various life safety regulatory issues incorrectly cited by the Tennessee Department of Health, resulting in a several thousand-dollar savings to the client who would have otherwise had to undertake major replacement of certain fixtures in their facilities. Long Term Care Facility Internal Investigation Represented a large national long term care company in the over year long investigation of allegations of abuse, neglect and misappropriation of property by an employee of one of the Company’s skilled nursing facilities. Representation included disclosure and negotiation with both state and local law enforcement officials. Long Term Care Provider – National Transaction Assisted with firm’s representation as local counsel to provide real estate and regulatory opinions in connection with the $1.8 billion dollar sale, merger and reorganization of a national long term care provider. Long Term Care Provider Change of Ownership Advised and assisted a long term care provider with the licensure, Medicare and Medicaid certification, and certificate of need issues related to the acquisition of multiple long term care facilities in three Southeastern states as part of an asset purchase and change of ownership in activities. Non-Profit Senior Housing Continuum Campus Advised and represented a national not-for profit long term care company in the development of a planned campus of long term care continuum services, including independent living through skilled nursing facility services. Project included the successful representation of the client to obtain a certificate of need under Tennessee law, and counseling on various regulatory issues. Nursing Facility Transfer Discharge Case Represented client in a transfer and discharge hearing. Facility staff was presented with significant problems created by the disruptive behavior of a patient in the facility. Worked with the facility and staff to evaluate the situation, and represented the facility in an administrative proceeding before TennCare. Situation was resolved through a negotiated settlement that included a behavior agreement, which resulted in the significant improvement in the behavior of the patient. Skilled Nursing Facilities – Injunction to Prevent Medicare Termination Represented various long term care facilities seeking federal court injunctions against the Department of Health and Human Services to prevent the decertification of their skilled nursing facilities. In conjunction, advised these clients on the recertification and/or sale of their facilities after termination proceedings. Skilled Nursing Facility – CON Legislation Successfully represented long term care provider in obtaining the introduction and passage of special purpose legislation that allowed the skilled nursing facility to partition its existing large facility into components, allowing them the ability to execute their strategic business plans. Skilled Nursing Facility - DAB Survey Appeals Handled many administrative regulatory appeals before the Centers for Medicare and Medicaid Services and its Departmental Appeals Board. In total, negotiate and/or litigated successful resolutions of these appeals saving providers at combined total of over $3.6 million. In conjunction with these appeals, Chris also assisted with regulatory compliance and survey enforcement matters, helped to develop plans of correction, interacted with regulators, and assisted with informal dispute resolutions. Negotiation and leasing of multiple operations for long term care provider Represented a regional long term care provider in the leasing of a package of 12 facilities, including the negotiation of the lease with a REIT, the negotiation of operations transfer agreements with the previous operator, the negotiation of working capital financing with a commercial lender, and overseeing the regulatory approvals related to the transaction.
