Physicians challenged by the changing reimbursement and regulatory landscape rely on Nelson Hardiman to navigate complex health care plan options that form the basis of Independent Physician Associations (IPAs). We negotiate health care plan agreements that deliver seamless solutions for IPA members beset by administrative burdens.

Our healthcare attorneys blend their next-level healthcare management skillset with expertise on payor compliance issues to advise IPA physicians on effective health care plan options. We work with you to identify plans and processes that work with your business structure – be it a nonprofit entity, a limited liability company, a corporation or other type of shareholder-owned entity. Our experience includes structures that allow members to care for patients outside of contracted health care plans. Bottom line, Nelson Hardiman delivers the power of strength in numbers to our IPA clients, ultimately providing a platform for IPA physician members to preserve capital and share risk, maintain independent practices, and participate in coordinated care to improve patient outcomes.

Our Work Includes:

  • Acquisition Negotiated the purchase and sale of an IPA offering forward-thinking care delivery and payment models to an equity investor based on the market potential for value-based care.
  • Business Litigation Represented an IPA in complex disputes regarding exclusive provider contracts, transactional misrepresentations, and shareholder disputes.
  • Compliance Advised an IPA in Palm Springs, California on Knox-Keene Act and Department of Managed Health Care (DMHC) solvency requirements for risk-bearing organizations.
  • False Claims Act Defended an IPA in False Claim Act/qui tam whistle-blower litigation about alleged claims violations involving the IPA’s healthcare plans.
  • Formation, Contracts and Operations Formed several new IPAs, merged physician practices, negotiated new contracts with Medicare Advantage plans, and counseled on business and regulatory aspects of IPA operations.
  • Reimbursement Audits and Investigations Represented numerous IPAs in reimbursement audit and investigations by governmental payors, including Medicare and Medi-Cal.
  • Stark and Anti-Kickback Compliance Counseled a primary care IPA on Stark and Anti-Kickback compliance and utilization review requirements in connection with a proposed new healthcare plan structure.