Legal Counsel for Healthcare & Service Providers

PRACTICE TYPES:

SERVICE TYPES:

TECH AREAS:

SERVICE AREAS:

ASSESSMENT INCLUDES:

• ✓ HIPAA privacy & security analysis
• ✓ Contract & vendor agreement review
• ✓ Regulatory compliance checklist
• ✓ Risk priority matrix

STRATEGY INCLUDES:

• ✓ Custom policy & procedure development
• ✓ Contract templates & negotiations
• ✓ Staff training programs
• ✓ Implementation roadmap

ONGOING SUPPORT:

• ✓ Regular compliance updates
• ✓ Contract review & updates
• ✓ Emergency breach response
• ✓ Strategic business counsel

📋 Administrative Safeguards:

• Designate a HIPAA Security Officer
• Conduct employee training and maintain documentation
• Implement access controls and user authentication
• Establish incident response procedures

🔒 Physical Safeguards:

• Secure workstations and media storage
• Control facility access and device controls
• Proper disposal of PHI-containing materials

💻 Technical Safeguards:

• Encryption of data at rest and in transit
• Audit logs and monitoring systems
• Automatic logoff and data backup procedures

💡 Pro Tip: Start with a comprehensive risk assessment to identify your specific compliance gaps and prioritize implementation efforts.

💡 Quick Test: If a vendor could potentially see, handle, or access patient information while providing services, they likely need a BAA.

🔍 Due Diligence Essentials:

• HIPAA compliance status and breach history
• Provider credentialing and licensing verification
• Payer contract assignments and termination clauses
• Employment agreements and non-compete restrictions
• Regulatory investigations or sanctions

📋 Regulatory Approvals:

• State medical board notifications
• DEA registration transfers
• NPI number updates
• Facility licensing transfers

💰 Financial Considerations:

• Accounts receivable collection risk
• Tail insurance coverage requirements
• Employee benefit plan transfers
• Working capital adjustments

⚠️ Critical: Start legal review early—healthcare practice transactions typically take 3-6 months due to regulatory requirements.

📊 Build Your Negotiation Foundation:

• Compile patient volume and outcome data
• Document cost-saving initiatives and quality metrics
• Research local market rates and competitor arrangements
• Identify unique value propositions (specialties, locations, services)

⏰ Timing Your Approach:

• Start negotiations 6-12 months before contract expiration
• Leverage payer's annual budget planning cycles
• Time discussions with quality reporting periods
• Consider market consolidation or competitor changes

💡 Negotiation Strategies:

• Focus on total cost of care, not just unit pricing
• Propose value-based arrangements with quality incentives
• Negotiate administrative simplification (prior auth reductions)
• Secure favorable termination and renewal clauses

💡 Pro Tip: Having alternative payer options strengthens your negotiation position—never negotiate from a position of total dependence.

🏥 Credentialing & Licensing:

• Primary source verification requirements
• Ongoing license monitoring and renewal tracking
• Background checks and exclusion list screening
• Malpractice insurance and tail coverage requirements

📝 Non-Compete & Restrictive Covenants:

• State-specific enforceability standards
• Patient relationship vs. geographic restrictions
• Reasonable duration and scope limitations
• Buy-out provisions and liquidated damages

🔒 Privacy & Confidentiality:

• HIPAA training and compliance obligations
• Patient information access controls
• Breach reporting and incident response
• Termination procedures for system access

⚠️ Note: Connecticut and New York have different standards for non-compete enforceability—ensure your agreements comply with applicable state law.

🚨 Immediate Actions (First 24 Hours):

• Contact legal counsel immediately (before responding to any requests)
• Preserve all relevant documents and electronic records
• Issue litigation hold notice to prevent document destruction
• Notify your malpractice insurance carrier

📋 Investigation Response Strategy:

• Review investigation scope and timeline requirements
• Develop document production protocol with legal counsel
• Prepare staff for potential interviews or depositions
• Coordinate with compliance officer and IT department
• Maintain normal operations while ensuring compliance

⚖️ Long-Term Defense Approach:

• Conduct internal investigation to understand potential issues
• Develop corrective action plan for any identified deficiencies
• Engage in proactive dialogue with regulators when appropriate
• Consider settlement discussions if violations are likely
• Implement enhanced compliance monitoring going forward

🚨 Critical: Never ignore regulatory notices or attempt to handle investigations without experienced healthcare legal counsel. Early legal involvement often determines the outcome.