Do I Need a Healthcare Attorney?

Healthcare industry is one of the top three most regulated industries in the United States.  Almost every aspect of a healthcare business process is regulated by more than 35 different agencies and organizations.  If you conduct business in healthcare, you should consider engaging a healthcare attorney to assist you with your legal questions.  Entities such as a hospital, laboratory, home health agency, hospice, nursing facility, physician organization, dentist group, surgery center, chiropractors, pharmacies, DMEPOS suppliers, electronic health companies, etc. to transact healthcare business, will at some point require consultation of a healthcare attorney.

WHAT DO HEALTHCARE ATTORNEYS DO?

Healthcare attorneys deal with a wide range of legal issues faced by their clients, from creating health policies, managing compliance, hiring employees and conducting business transactions to representing clients in business negotiations, or criminal and civil litigations brought by federal and state oversight agencies.  

In assisting healthcare organizations with their business needs, healthcare attorneys provide advice on complex healthcare regulations, such as fraud and abuse statutes; draft and review contracts; create internal compliance policies; or negotiate acquisition deals, for example.  If there are potential civil or criminal violations, healthcare attorneys will represent clients in investigations, audits and litigations.  For instance, healthcare attorneys represent businesses and institutions with issues such as privacy and security compliance, assist with purchase or sale of practices, or in audits and investigations instigated by federal and state agencies, such as the Center for Medicare and Medicaid (CMS), Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) and the Office of Civil Rights (OCR). 

Healthcare lawyers also work with individual practitioners to advice on issues arising from healthcare services.  For example, a healthcare attorney can represent a hospital employee in negotiating their employment agreement or dispute and adverse peer review process as a hospital staff.  Healthcare attorneys also represent practitioners before credentialing organizations, such as American Board of Medical Specialties or state health boards, such as state board of medicine, nursing, or dentistry.

Finally, healthcare attorneys represent technology companies who provide services in the healthcare industry, such as telehealth companies, electronic medical records companies, billing companies, remote patient monitoring companies, etc. with respect to compliance of their software and technology with state and federal healthcare rules and regulations.

WHEN DO I NEED A HEALTHCARE ATTORNEY?

If you or your organization have questions about the following health law topics, you should consider contacting a healthcare attorney:

• Compliance with healthcare statutes or regulations, such as HIPAA, HITECH, Antikickback Statutes, Stark Law, False Claims Act, EMTALA;

• Contracts with healthcare vendors, such as billing contracts, marketing contracts, hospital staff agreements, directorship agreements, joint venture contracts;

• Company policies, such as HIPAA policies and procedures;

• Employment agreements with healthcare professionals;

• Management agreements;

• Integrated health organizations;

• Telehealth services;

• Government investigations and audits, such as by OIG, OCR or CMS.

HOW MUCH DOES A HEALTHCARE ATTORNEY COST?

Depending on your type of legal issue, the charging method of a healthcare attorney may vary.  For example, some healthcare attorneys review contracts on a flat fee basis, but bill hourly for negotiating agreements or conducting due diligence on a purchase transaction.

Although a variety of billing methods are used by healthcare attorneys depending on the type of legal issue before them, below are a few examples of some of the methods you may encounter:

Billable Hour Method:  Under this method, a healthcare attorney would bill for each hour and faction of hour that he/she spends on your legal issue.  This is the most common form of billing by healthcare attorneys.  Typically, when billing hourly, attorneys charge in fractions of an hour.  For example, when an attorney charges on a 6-minute fraction, it means that he/she will bill at least 6 minutes of time even if an interaction with client takes only 3 minutes.  Prior to engagement of any attorney, it is important to determine what hourly fraction the attorneys bill under.   These little time fractions can add up over time!

Flat Fee Method: Under this method, the attorney would agree to a predetermined flat fee for the legal project.  This means that the attorney will charge the flat fee amount regardless of whether the actual billable hours spent on the project is more or less than the flat fee amount. 

Capped Fee Method:  Under this method, a healthcare attorney commits to a capped fee amount.  A capped fee amount sets a top dollar limit that the attorney cannot exceed in working on the project.  But, unlike in the Flat Fee Method, if the billable hourly amount is less than the predetermined capped fee, the attorney will charge the lower amount.  Thus, this is a more favorable method for the client as compared to the flat fee method.

Contingency Method: This method is suitable for legal claims upon successful resolution of which the client is awarded a sum of money.  While this method is not often used by healthcare attorneys, if implemented, the attorney undertake the financial risk of the legal project, such as costs of experts during trial and representation, in return for a pre-agreed upon percentage of the fees the client would receive upon successful resolution of the legal issue.  This method is mostly employed by non-healthcare law attorneys, such as Medical Malpractice Attorneys, or in legal disputes against rejected insurance claims.    

Most healthcare attorneys charge on an hourly basis and the hourly rate varies widely, with larger firms typically charging a higher fee as compared to smaller firms. 

In finding a healthcare attorney that would meet your legal and budgetary needs, you should interview several healthcare attorneys at different firms to determine the rates that meet you budget and a structure that would work for your legal project.    

WHAT SHOULD I EXPECT WHEN WORKING WITH A HEALTHCARE ATTORNEY?

Regulatory compliance plays an important role in any healthcare transaction and healthcare attorneys are trained to guide you through the complex regulatory frameworks in this industry.  You should expect your healthcare legal counsel to assist you to identify costly legal pitfalls and avoid legal complications in the future by crafting your company policies and contracts in compliance with rules and regulations.

You should expect to involve healthcare attorneys in major decisions in your organization to ensure all your processes are compliant.  You should also expect to review your business transactions with a healthcare attorney to avoid violations of healthcare regulations. 

In the event of audits or investigations, it is important to involve a healthcare attorney early so he/she can protect your and your organizations’ legal rights before state and federal agencies.

Healthcare attorneys are your best resource to properly manage the legal issues of your organization and effectively navigate through the complex healthcare regulations.

At G2Z Law Group, PLLC, our healthcare attorneys provide guidance to a wide range of clients regarding different aspects of the healthcare law.

CONTACT US so we can assist you with your legal questions.