Post-Acute and Long-Term Care

Holland & Knight attorneys are leaders in representing providers of post-acute care, long-term care, hospice and palliative care, and home healthcare services across the United States. Providers rely on our experience and insight with a wide range of transactional, regulatory and operational issues. Our Post-Acute and Long-Term Care Team assists investor-owned and not-for-profit providers, freestanding and hospital-based providers, as well as national and regional operators of a wide range of facilities and services, including:

• long-term acute care hospitals (LTACHs)
• rehabilitation hospitals and therapy providers
• skilled nursing facilities
• home healthcare agencies
• senior living providers
• residential care and assisted living facilities
• hospice and palliative care providers, including home hospice care
• home care/private duty providers

For various care-at-home models, there are a discreet set of local, state and federal legal issues, including corporate practice of medicine limitations, site-of-service restrictions, scope of practice professional considerations, supervision requirements, reimbursement issues, telehealth regulations and licensure requirements. In many cases, the regulations have not fully caught up with the various business models that are being adopted, and the Centers for Medicare & Medicaid Services (CMS) and states are actively experimenting with waivers, pilot programs and new reimbursement methodologies.

Business and Finance Transactions

We advise post-acute care, long-term care, hospice and home healthcare providers in strategic acquisitions, divestitures and joint ventures with hospitals, health systems and accountable care organizations (ACOs). We provide sophisticated yet practical advice to healthcare acquirers, targets, sellers, investors and boards of directors. Our attorneys also negotiate equity investments, capital financing arrangements and other transactional structures on behalf of providers and lenders in this key segment of the healthcare industry. Our transactional experience includes real estate and finance transactions, as well as corporate structuring and restructuring. We provide counsel to companies, investors and lenders on debt securities, high-yield notes, capital market offerings, and bond and public finance transactions. Holland & Knight has extensive experience advising private equity, venture capital and angel investors that are active across the healthcare industry. Our lawyers also represent lenders, agents and borrowers in a variety of healthcare finance transactions, including loans to owners and operators of post-acute and long-term care facilities and home healthcare agencies.

Government Investigations and Audits

Holland & Knight represents post-acute and long-term care providers in an array of government investigations and audits, advising on the full range of regulatory issues governing such providers. Our team has a number of seasoned attorneys with prior government experience, including former federal and state prosecutors and agency counsel. When faced with a government investigation or enforcement action, our lawyers help clients respond appropriately with strategies aimed at minimizing – or completely avoiding – penalties, negative publicity and disruptions to core business operations.

We have successfully represented post-acute and long-term care providers, boards of directors and executives in federal and state criminal, civil and regulatory enforcement matters across the country, including False Claims Act (FCA) investigations. Holland & Knight attorneys also have extensive experience representing post-acute and long-term care providers in U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) and Unified Program Integrity Contractor (UPIC) audits, and have successfully overturned audit overpayments through the Medicare appeals process. Our attorneys draw from the firm's extensive healthcare regulatory and operations knowledge in order to quickly understand and proactively respond to any government investigation or audit.

Litigation and Dispute Resolution

In addition to government investigations and audits, Holland & Knight attorneys have the knowledge and experience to protect clients in a variety of other litigation matters, including commercial or contract disputes, labor relations disputes, resident or "whistleblower" complaints, and all types of court or administrative agency proceedings. Our attorneys have a wealth of experience and record of success in guiding our healthcare clients through all aspects of the litigation process. We also have lawyers from a wide range of practice areas who have substantive experience in advocating for clients in mediation and arbitration proceedings.

Regulatory Compliance and Operations

Holland & Knight attorneys assist and advise post-acute and long-term care providers on all aspects of regulatory compliance and operational matters. We provide counsel on state licensure and change of ownership issues, Medicare and Medicaid enrollment and reimbursement matters, and federal and state fraud and abuse laws, including the Anti-Kickback Statute, Stark Law and FCA. Our attorneys also advise on compliance with the Health Insurance Portability and Accountability Act (HIPAA) and state privacy regulations, as well as a wide range of labor and employment matters, including defense of wage and hour complaints and discrimination charges.

Real Estate

Holland & Knight has extensive experience with transactions ranging from large-scale, multistate portfolio transactions to single-asset deals involving the entire spectrum of long-term care facilities, including skilled nursing, assisted living, memory care and continuing care facilities. Our attorneys advise owners, operators, developers and managers in a wide variety of commercial real estate transactions in the post-acute care and long-term care segments. We also help clients assemble real property portfolios, perform nationwide due diligence, prepare conveyance and transition documents, as well as assist with the navigation of various regulatory components involved in these transactions.

Labor and Employment

Healthcare employers have unique legal needs, and Holland & Knight lawyers have a thorough understanding of the industry-specific factors that affect employers providing post-acute care, long-term care, hospice and palliative care, and various home care services. We represent providers in labor and employment disputes before the U.S. Equal Employment Opportunity Commission (EEOC), National Labor Relations Board (NLRB) and U.S. Department of Labor (DOL). Our attorneys help ensure that providers' pay practices comply with the Fair Labor Standards Act (FLSA) and state law requirements.

Policy, Regulation and Licensing

Holland & Knight is committed to protecting our clients' interests in licensure, regulatory, legislative and public policymaking matters by drawing on our experience and knowledge regarding precisely how, where and when to intervene on your behalf. Our attorneys and policy advisors protect the interests of post-acute and long-term care providers by monitoring and lobbying federal and state legislative and rulemaking initiatives that affect them, guiding them through the licensure process, and working with governmental agencies to resolve problems related to licensure, certification and facilities regulation.