Hospitals and Health Systems

Service to hospitals and health systems is the cornerstone of Holland & Knight's healthcare law practice, the largest of any law firm in the United States. We understand the critical role that hospitals and health systems play in our communities, and our healthcare attorneys help to remove obstacles that can disrupt the treatment of patients and limit access to healthcare services.

Holland & Knight's deep roster of healthcare attorneys has the experience to provide comprehensive representation to hospitals and health systems, including tax-exempt organizations, academic medical centers, investor-owned companies and publicly owned hospitals. Ranked among leading healthcare law firms nationwide by Chambers USA, Holland & Knight is a go-to law firm for hospitals and health systems.

Clients rely on our Hospitals and Health Systems Team for transactional, regulatory and operational assistance so they can focus on their primary mission – caring for the patients and communities they serve.

Comprehensive Services

Representing hospitals and health systems in nearly every state, our attorneys help clients respond to the opportunities and challenges unique to this sector of the healthcare industry, including:

• mergers and acquisitions (M&A) and joint ventures
• government investigations, including fraud and abuse matters involving False Claims Act (FCA) and qui tam litigation
• Medicare/Medicaid certification and reimbursement
• Stark Law and Anti-Kickback Statute (AKS) compliance
• data privacy and security, including Health Insurance Portability and Accountability Act (HIPAA) privacy, compliance and identity protection
• healthcare finance and securities
• intellectual property, technology licensing and innovation strategies
• federal and state policy and advocacy
• real estate, including facility development, acquisition and divestiture
• employment disputes, labor relations and healthcare immigration
• medical staff credentialing and related matters
• contracting issues and disputes
• environmental and medical waste issues

In the tax-exempt and nonprofit sector, we also assist healthcare providers with:

• creating ancillary revenue streams, including through data monetization
• divesting non-core assets, including disposition of outreach laboratory services
• obtaining and maintaining tax-exempt status with the IRS and state tax authorities
• providing counsel regarding excise taxes on prohibited transactions
• structuring advice related to unrelated business income tax (UBIT) and private inurement issues
• working with the IRS to obtain private letter rulings on a variety of issues

Hospital M&A and Joint Ventures

M&A, joint venture and divestiture transactions involving hospitals and health systems require legal skill and industry experience to provide effective counsel on the issues and nuances particular to this sector. Holland & Knight attorneys have successfully structured and closed many noteworthy transactions in the hospitals and health systems space. We structure deals to meet the particular goals and objectives of each client, whether a large health system or an independent hospital.

In addition to our hospital transactional and regulatory lawyers, hospitals and health systems also turn to experienced Holland & Knight colleagues across various practices for counsel on healthcare-specific matters involving tax, antitrust, real estate, labor and employment, and many other issues that may impact a transaction.

Whether structuring and negotiating a merger, shepherding a complicated acquisition, creating a new alliance or restructuring to create a more successful enterprise, our attorneys have the industry, regulatory and transactional experience necessary to effectively and efficiently see the transaction through every step of the process – from the initial analysis of legal alternatives to an effective and successful close.

Within the current antitrust enforcement climate, healthcare providers must manage the antitrust risks associated with increased government scrutiny. Our healthcare antitrust attorneys have extensive, hands-on experience and provide proactive counsel to help clients identify – and avoid – potential competition issues before they become problems.

Hospital Operations and Regulatory Compliance

From day-to-day operational issues to long-term strategic matters, our healthcare attorneys work to understand our clients' objectives and then develop effective strategies for achieving their goals. The depth and breadth of our regulatory experience is central to our mission. Our operational and compliance counsel to hospitals involves:

• federal regulations, including:
  • Medicare/Medicaid enrollment, certification and reimbursement
  • Stark Law and AKS compliance
  • Emergency Medical Treatment and Active Labor Act (EMTALA)
• state licensure and certifications, including Certificate of Need (CON) applications and opposition
• data security and patient privacy, including HIPAA patient privacy and security regulations; electronic storage and transfer of medical records, electronic payment systems, security programs under the Health Information Technology for Economic and Clinical Health (HITECH) Act and data breaches.
• Medicare reimbursement audits conducted by zone program integrity contractors (ZPICs), recovery audit contractors (RACs) and Medicare administrative contractors (MACs)
• regulatory investigations and audits, including:
  • U.S. Department of Justice (DOJ), U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) and Medicaid Fraud Control Unit investigations and enforcement actions
  • allegations of violations of the FCA, AKS and Stark Law

Legislative and Policy Advice

The hospital industry operates in a challenging legislative and regulatory environment. Our Hospitals and Health Systems Team works closely with colleagues on Holland & Knight's Healthcare & Life Sciences Policy Team, which consists of seasoned legislative and regulatory attorneys, non-lawyer lobbyists and public relations professionals who bring hands-on experience, depth of practice and industry insight to bear on legislative and policy matters. We provide full-service, turn-key government strategy solutions that champion our clients' objectives. Our attorneys and policy advisors have vast knowledge and experience in legislative drafting and analysis, development of regulatory strategies, identifying and securing federal funding, and policy forecasting that informs client business plan development.

Healthcare Labor, Employment and Immigration

Holland & Knight attorneys have a deep understanding of the industry-specific characteristics of healthcare employers, including the relationships among administration, employees and medical staff, as well as the sensitivity toward the industry's complex regulatory environment, Joint Commission and other accrediting requirements. This enables us to fully serve the distinct labor and employment needs of healthcare organizations locally, regionally and nationally.

Our attorneys also advise healthcare providers in all facets of corporate immigration law. Holland & Knight lawyers have assisted clients in helping hundreds of physicians and allied healthcare professionals – including nurses, physical therapists, occupational therapists, medical technologists, physician's assistants and nurse practitioners –obtain Conrad 30 J-1 waivers, H-1B visas, National Interest Waivers and other necessary certifications to enter the country from abroad and work as healthcare professionals in the United States.

Real Estate

Holland & Knight's Healthcare Real Estate Team includes a group of attorneys who dedicate their practice to counseling clients in the purchase, sale, development, management, leasing and financing of acute care and specialty hospitals, medical office buildings, medical condominiums, outpatient facilities, urgent care centers, senior housing and skilled nursing facilities across the United States. Our attorneys handle all aspects of our clients' real estate needs, from large-scale, multistate portfolio transactions to single-asset deals. We understand the healthcare regulatory environment and the potential hazards related to Stark and AKS issues that can arise in healthcare real estate matters.

Litigation

Working in tandem with skilled attorneys from Holland & Knight's Healthcare Litigation Team, our Hospitals and Health Systems Team advises clients in complex litigation matters such as privacy and other class action defense – including disputes with third-party payers and physician groups. When you are facing complex investigation and peer-review proceedings, including fair hearing and litigation involving professional review actions taken, working with lawyers who have extensive experience in general commercial litigation – such as contract disputes with vendors and insurers – is an important step toward a positive outcome.

Government Enforcement Defense

Our attorneys help hospital clients confronted with government investigations or enforcement actions with strategies aimed at minimizing – or completely avoiding – penalties, negative publicity and disruptions to core business operations. Holland & Knight attorneys have successfully represented healthcare organizations, individual providers, boards of directors and executives in federal and state criminal, civil and regulatory enforcement matters across the country. As part of our holistic approach to client service, our attorneys draw from the firm's extensive healthcare regulatory and operations knowledge to evaluate and respond proactively to government enforcement actions and investigations.