Bradley lawyers have partnered and achieved success with our clients in post-acute and long term care for over 30 years. We boast an experienced and multidisciplinary long term care and senior housing legal team that understands the business of post-acute care and how it affects a client’s legal needs.

For decades, Bradley has been deeply involved in industry trade associations and policy related to long term care. Our firm represents clients in all facets of their services and plans, including transactional, litigation, and regulatory work. Clients include owner/operators, managers and support services providers, developers, investors, lenders, and other debt and equity sources, as well as real estate investment trusts (REITs), national chains, independent owners, nonprofits, and faith-based providers. We also counsel organizations providing ancillary services such as home health, dialysis, rehabilitation, pharmacy, behavioral health, and hospice. In 2022 alone, we assisted clients in closing over $3 billion in long term care and senior housing transactions. 

Bradley’s post-acute and long term care clients include:

  • Skilled nursing facilities and nursing homes
  • Assisted living facilities, personal care, and memory care centers
  • Continuing care retirement communities/life plan communities
  • Independent living facilities
  • Behavioral healthcare centers
  • Home health and hospice providers
  • Rehabilitation therapy
  • Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)

We provide a full spectrum of health law services to post-acute and non-acute care providers, including:

  • Acquisitions and dispositions, leasing, negotiation of management and support services agreements, and other transactional matters
  • Licensing and certification
  • Defense of civil and criminal False Claims Act and anti-kickback issues
  • Developing and implementing operational and compliance programs
  • Managed care integration, including M&A, HIPAA, litigation, ancillary service agreements, and occupancy issues
  • Risk management, including cybersecurity, physical security, and privacy
  • Real estate development and construction financing
  • RIDEAs and other corporate joint ventures
  • Intergovernmental transfers (IGT) and QIPP
  • Financing, including bridge lending, HUD-insured and other agency financing, mezzanine lending, accounts receivable lending, and preferred equity
  • Distressed assets and creditors’ rights issues

Our team routinely advises long term care companies in connection with their acquisitions, dispositions, restructuring and reorganizations, leasing, financing, development, and construction, whether single asset deals or portfolios. We have extensive experience partnering with our clients on compliance with state licensure and federal certification requirements at their facilities. We work with clients to resolve regulatory issues with government agencies, including responding to citations with plans of correction and advising on and litigating appeals of survey non-compliance.

Bradley’s extensive experience in survey and certification matters allows us to be a knowledgeable partner to our clients when conducting due diligence in acquisitions and financial transactions, as well as assisting providers in developing and implementing various types of business agreements, including operating leases and management and support services agreements. We are particularly familiar with RIDEA structures and all components necessary for the successful completion of CHOWs and CHOMs, including interim sublease and management structures. Our team understands the relevance of the CARES Act and FEMA on the industry, including the rules regarding the Paycheck Protection Program, HHS Grants, and Medicare Advance/Accelerated Payments, and their impact on long term care transactions.

Our team assists lenders and borrowers in all aspects of healthcare financing, including credit facilities, mortgage loans, mezzanine and A/B financing, revolvers/working capital loans (asset-based lending), and seller financing. We are involved in bridge-to-HUD and agency lending, and handle participations, syndications, warehouse lines, note sales, and loan securitizations, as well as the full range of loan servicing issues. We also counsel tax-exempt clients in borrowing funds through the issuance of tax-exempt bonds, including bond authority approval, trust indentures, loan agreements, security agreements and other bond documents.

Our team has collective experience closing hundreds of HUD-insured loans for lenders and borrowers, totaling more than $1 billion in transactions. Many of these HUD-insured loans include master lease structures and accounts receivable financing and other items adding complexity to the closing. We assist lenders and borrowers in navigating the challenges related to structuring and closing HUD transactions and their post-closing asset management work, including change of participant transactions (historically known as transfers of physical assets (TPAs)) for facilities with existing HUD financing, interest rate reductions, and acquisitions of HUD-foreclosed properties.

Bradley works with clients to minimize risk and maintain compliance with HIPAA, the Deficit Reduction Act, the Anti-Kickback Statute, the False Claims Act, and comparable state laws that present risk for civil or criminal liability. When needed, we coordinate and conduct internal investigations and assist clients in investigations conducted by state Medicaid Fraud Control Units, as well as the U.S. Department of Justice and U.S. attorneys.

Our team stays up to date on changing self-reporting requirements and provides reasoned advice on approaching and disclosing potential problem areas to regulatory authorities. We have successfully limited client exposure and managed countless investigations through their conclusions or through litigation brought by governmental entities or qui tam relators. We also assist with the negotiation and monitoring of Corporate Integrity Agreements.

Bradley attorneys work closely with clients on their operational needs, both before and after issues arise. Our lawyers are adept at guiding providers through legal and regulatory processes, as well as acting as liaisons to the governmental and regulatory agencies that oversee the operations and activities of our clients. We routinely negotiate management and support services agreements, provide state compliance analysis for resident agreements, and advise clients on corporate governance and compliance, including QAPI and audits. We provide training and can assist with poor survey tags, red flags, survey ratings, Immediate Jeopardy citations, and Special Focus Facility designations. 

Bradley is here to assist in the event of privacy and security incidents and is experienced in health IT, information security, and privacy, including electronic health records (EHRs), HIPAA, software and technology licenses and lease agreements, data sharing agreements for health information exchanges (HIE), and vendor dispute resolution. Our team includes three healthcare attorneys who are certified through the International Association of Privacy Professionals (CIPP/US) to assist clients through privacy incidents.

As managed care has shaped the delivery of long term care services and supports, Bradley’s healthcare attorneys have counseled both acute and long term care clients on these aspects of healthcare integration. We regularly assist with negotiating and drafting revisions to managed care contracts. Bradley attorneys have created and advised integrated networks, such as accountable care organizations (ACOs), and we advise clients on matters involving their provider-sponsored Medicare special needs plans.

Our broad experience in the healthcare field means our lawyers have the tools to handle the unique challenges of designing a program for managed-care integration. We understand the intricacies of the complex rules and regulations of Medicare, Medicaid, Medicaid-waiver, and other third-party payor systems and work with post-acute care providers in all aspects of these critical funding systems.

Based on their sophisticated understanding of the industry, our attorneys can ably assist clients with the development and construction of long term care and senior housing facilities. We provide assistance with Certificates of Need (CONs), life safety and code compliance, and general construction counseling, helping to avoid unanticipated delays and potential liabilities. With decades of involvement in the field, we help navigate the specific issues, concerns, and regulations that providers face within the larger real estate context. Attorneys in Bradley’s nationally recognized Construction Practice Group work closely with clients in the long term care and senior housing industries through all phases of the construction and procurement process.

Bradley handles defaulted loans and major bankruptcies in the long term care market, including litigation and transactions related to bankruptcy, insolvency, loan workouts, receiverships, collections, repossessions, foreclosures, lien disputes and other matters affecting debtor/creditor relationships. As an example of our results for our long term clients, Bradley’s interdisciplinary team of bankruptcy and healthcare attorneys was recognized for a complex $120 million Chapter 11 restructuring case involving 18 related entities and 14 long term care facilities for Vanguard Health.

Our attorneys have experience in all facets of representing borrowers/facilities, the lenders, and purchasers of distressed communities out of bankruptcy and receiverships. 

Bradley defends claims for long term care clients involving abuse and neglect, provider malpractice, slip and falls, loss run analysis, captives, and violations of federal and state regulations. Working closely with clients and in-house counsel, our attorneys can manage litigation and discovery efforts and oversee other outside counsel in the defense of claims.