Advised on the acquisition of five metro Atlanta hospitals by a Georgia-based nonprofit system, with oversight of healthcare regulatory, licensure, and payer considerations.
Served as regulatory counsel in the merger of a Georgia health system with a regional provider, addressing multi-jurisdictional licensure, reimbursement, and enrollment transitions.
Served as healthcare regulatory counsel in the acquisition of an academic medical center by a Georgia-based nonprofit health system.
Counseled nonprofit and regional health systems in structuring joint ventures with post-acute providers, including inpatient rehabilitation facilities, LTACHs, skilled nursing facilities, and home health agencies.
Advised health systems and physician groups on structuring chronic care management programs and related value-based initiatives, including telehealth integration, scope of practice compliance, and reimbursement alignment.
Advised health systems in structuring shared savings and value-based care arrangements with physician groups and post-acute care providers, with a focus on compliance with the Stark Law, Anti-Kickback Statute, and civil monetary penalties law.
Structured care coordination and gainsharing arrangements, including co-management agreements and performance-based incentive models for inpatient and outpatient service lines.
Developed alignment strategies between hospitals and independent provider groups to support clinical integration, care redesign, and network participation in payer-driven alternative payment models.
Reviewed and negotiated value-based payment terms in health system agreements with post-acute networks, focusing on care transitions, quality metrics, and downstream cost accountability.
Provided legal and strategic guidance on aligning value-based initiatives with provider-based compliance, particularly in contexts where new HOPDs or outpatient departments are integrated into systemwide clinical and financial alignment strategies.
Led licensure and regulatory components of large-scale hospital rebranding efforts, including state and federal payer notifications, provider enrollment updates, and operational transition planning.
Secured expedited licensure waivers and variances for health systems seeking operational flexibility in hospital and facility management during time-sensitive expansions.
Advised on the regulatory and licensure aspects of ASC and post-acute joint ventures, including change of ownership (CHOW) filings, payer enrollment, and operational compliance across multiple states.
Managed all regulatory aspects of healthcare system acquisitions, including CHOW notifications to CMS, Medicaid agencies, state departments of health, and private payors at the federal, state, and local levels.
Represented health systems in Medicare and Medicaid enrollment and billing disputes, including resolution of provider-based status challenges and reimbursement issues.
Served as lead regulatory counsel in the $2.2 billion acquisition of a publicly traded healthcare services company by a private equity firm, addressing healthcare compliance across multiple sectors.
Served as lead regulatory counsel to a multinational investment bank in financing the $950 million acquisition and merger of two pediatric home healthcare platforms, now the largest of its kind in the U.S.
Advised hospitals and health systems on converting ancillary and physician practice locations into provider-based hospital outpatient departments (HOPDs), ensuring alignment with CMS’s provider-based regulations under 42 C.F.R. § 413.65 and applicable state licensure requirements.
Led regulatory strategy for HOPD conversions, including provider-based attestations, billing realignments, facility branding, and compliance with location-specific operational standards.
Managed Medicare Administrative Contractor (MAC) and state agency notifications, change requests, and enrollment updates to meet all provider-based regulatory timelines and avoid reimbursement interruptions.
Counseled clients on maintaining 340B eligibility during facility expansions and conversions, ensuring that new outpatient locations were properly registered on the HRSA Office of Pharmacy Affairs Information System (OPAIS) and aligned with Medicare Cost Report filings.
Reviewed internal controls and operational workflows to ensure 340B program compliance, including patient eligibility, mixed-use inventory tracking, and contract pharmacy arrangements.
Advised clients on the intersection of 340B and provider-based rules to prevent disqualifying practices, such as billing misalignment, non-compliant registration of outpatient sites, or miscategorization of reimbursable services.
Assisted in the development of compliance policies and procedures for newly established or acquired HOPDs participating in the 340B program, with attention to audit preparedness and mitigation of duplicate discounts and diversion risks.
Structured physician compensation and investment arrangements for hospitals, health systems, and post-acute providers to comply with the Stark Law, Anti-Kickback Statute, and state fee-splitting laws.
Advised physician practices and health systems on developing compliant ancillary service arrangements, including imaging, pharmacy, and clinical laboratory services.
Counseled healthcare providers on supervision, mid-level practitioner scope of practice, and fraud and abuse compliance related to telehealth and ancillary services.
Led internal investigations and compliance reviews focused on federal and state reimbursement practices, billing integrity, and potential overpayment liability.
Assisted in defense of a Florida health system in a federal False Claims Act case involving allegations of Stark Law violations related to oncology services.
Secured dismissal of whistleblower claims in a qui tam suit alleging improper IDTF enrollment practices by a radiology group.
Negotiated favorable resolution of a DOJ investigation into supervision deficiencies in a radiation oncology program under the False Claims Act.
Represented a multinational pharmaceutical company in connection with a DOJ investigation into patient assistance programs, specialty pharmacy practices, and drug pricing compliance.
Developed enterprise-wide compliance training programs — including department-specific modules for sales, marketing, and clinical staff — for a global medical device manufacturer.