More than ever, the healthcare system and the delivery of healthcare services is dynamic and ever-evolving. Now faced with a series of new — and still changing — laws regarding data privacy and electronic recordkeeping, healthcare professionals must constantly juggle caring for patients, fulfilling the requirements of affiliated hospitals and insurance companies, running their businesses, and complying with the law. The only way to operate successfully in this continuously morphing sector is to work with legal advisers who can address complex regulatory, risk management, corporate and operational issues.
For more than three decades, the attorneys of Abramson & Abramson have devoted a large part of our practice to representing physicians and other healthcare professionals and entities in connection with licensing, credentialing for hospital and insurance companies, due-process hearings, Medicare and Medicaid reimbursement issues, defense of state and federal criminal proceedings and Federal False Claim Act penalty cases.
As part of our commitment to the healthcare sector, we have become extensively involved in civil matters for professionals who find themselves in need of advice and guidance. Our work in these matters has led many professionals to seek the firm’s assistance in partnership and shareholder disputes involving restrictive covenant enforcement and defense, and actions against hospitals and insurance companies, in which these entities are attempting to exclude the healthcare provider from participation on staff or in network.
As a sample of our experience, we have represented:
- Physicians in disputes regarding their board certifications and certification eligibility.
- Physicians in disputes regarding payment with insurance providers.
- Physicians in disputes with management companies in connection with concierge physician services.
- Medical practices and facilities in disputes with employee physicians.
- Physicians in disputes with hospitals regarding credentialing, re-credentialing and employment agreements.
- Physicians, physician’s assistants, nurses, podiatrists and other providers in matters before the State Boards of Medicine, Osteopathy, Nursing, Podiatry and other specialties.
- Foreign medical graduates in disputes with Educational Commission for Foreign Medical Graduates (ECFMG).
- Physicians in disputes with the National Resident Matching Program (NRMP), including the defense of irregular-behavior allegations.
- Physicians in disputes with the National Board of Medical Examiners (NBME) and the United States Medical Licensing Examination (USMLE) Program, including the defense of irregular-behavior allegations.
- Providers of medical services in matters before administrative law judges.
Recent, representative engagements include the following:
- Defended clients in nearly two dozen Medicare and Medicaid fraud criminal trials.
- More than two dozen hearings before federal, state and administrative agencies, including licensing, DEA participation, Medicare and Medicaid participation.
- Defended and negotiated numerous Federal False Claims Act claims and proceedings.
- Represented physicians in more than 25 disputes with hospitals involving credentialing, restrictive covenants, contract buy-outs, fair hearings and the like.
- Tried to completion multiple partnership and shareholder separation disputes.
- In two separate cases, brought about the successful reinstatement of physicians where their credentials to participate in an insurance network had been revoked.
- Successfully prosecuted an injunction requiring an insurance company to reinstate a provider and to reimburse well over $150,000 for claims previously denied.
- Caused physicians threatened with termination from a hospital staff to be retained, without any negative Practitioner Databank consequences.
- Negotiated multiple settlement agreements with various insurance providers regarding alleged overpayments to a practitioner.
- Obtained an injunction against the Educational Commission for Foreign Medical Graduates, resulting in the reinstatement of the physician’s ECFMG certificate.
- Negotiated a settlement on behalf of a physician who became embroiled in a dispute with a hospital over medical office space.
- Defended a physician alleged to have engaged in “irregular behavior,” resulting in no adverse action taken against the physician by ECFMG, NRMP or the Electronic Residency Application Service (ERAS), and no report to the Federation of State Medical Boards (FSBM).
While all cases are different and past success is no indication of a future result, our attorneys undertake to provide our clients with the highest level of legal service.