Nelson Hardiman solves the toughest regulatory and business challenges impacting long-term care providers. We help managed care institutions face industry-wide challenges that will increase in the coming decades, driven by a growing demand for services as 78 million baby boomers approach retirement age, straining an over-burdened system.

We understand the complexities of the long-term care industry and successfully counsel long-term care providers before regulatory boards, in government audits, and in transactional matters. We have dealt with every imaginable legal issue from licensing to operations to reimbursement. We defend against government fraud investigations and whistleblower False Claims Act cases. We are innovators committed to helping providers navigate legal challenges and develop new service models and technologies for long term care.

Nelson Hardiman applies a wealth of experience to the issues surrounding aging in America to counsel residential care facilities for the elderly (RCFEs), the fastest growing component of long-term care in the U.S. Well-versed in all aspects of the increasingly stringent regulatory climate, we also deliver on the underlying policy, business and strategic needs of assisted living facilities.

Our seasoned healthcare attorneys apply decades of healthcare industry experience to advise and defend the growing numbers of assisted living facilities beset by acuity of patient health issues, accompanied by greater risks for elder abuse claims. Our sophisticated corporate team negotiates the acquisition and development of RCFEs and related business transactions, mirroring the industry-wide consolidation in healthcare services. Attune to the long-term challenges facing U.S. healthcare and how they are likely to play out in practical terms, Nelson Hardiman has the inside track on delivering legal solutions for assisted living facilities.

Our Work Includes:

  • Acquisition Handled the purchase of an assisted living facility.
  • Contracts Prepared, reviewed, and defended professional staff and resident admissions contracts for a large assisted living facility.
  • Department of Social Services (DSS) Handled DSS license application requirements, investigations and hearings for a Los Angeles based assisted living facility.
  • Finance Advised assisted living facility on entity formation and development of a business structure to support the facility’s financing needs.
  • HIPAA Counseled a facility on federal and state patient data privacy and security requirements and developed a compliance program.
  • Licensing Advised assisted living facilities on compliance with California licensing and operational requirements.
  • Litigation Defended business claims, including a shareholder dispute, for an assisted living company.
  • Medi-Cal Assisted Living Waiver (ALW) Advised several assisted living facilities on program participation.
  • Risk Management Advised and defended an assisted living facility on risk management policies and procedures and related issues of elder abuse and care.

In the ongoing healthcare revolution, the preference for home care aligns with government and payor desire to reduce costs. This convergence, coupled with growing technological support, fuels interest in convalescing at home. New care delivery models and consumer demand stoke tectonic shifts in the competitive landscape, creating challenges and opportunities for home health agencies to collaborate with other healthcare providers to extend patient care into alternative care settings. Nelson Hardiman’s solution-oriented experience across the full spectrum of alternative care issues offers home health agencies the regulatory oversight and strategic vision to accomplish their business goals in an evolving healthcare universe.

Our Work Includes:

  • Audit Defense Defended Zone Program Integrity Contractor (“ZPIC”), Recovery Audit Contractor (“RAC”), and Program Integrity Safeguard (“PSC”) audits for home health agencies.
  • Business Advised a L.A. based home health agency on the full range of business needs, from entity formation, business structure, and purchase and sale agreements to professional, executive, payor and vendor contracts and service, employment and independent contractor agreements.
  • Compliance Handled licensing, operational, and reimbursement compliance, Medicare and Medi-Cal enrollment, corrective action plans and other compliance strategies for a home health agency.
  • Data Privacy Advised on HIPAA and state patient data privacy and security requirements, including program development, for a large home health agency.
  • False Claims Act Handled compliance for marketing and business development activities and qui tam whistle-blower litigation defense.
  • Fraud and Abuse Investigations Defended investigations by government payors and their contractors including Safeguard Services, Office of Inspector General, Federal Bureau of Investigations, Department of Justice, Department of Health Care Services, Bureau of Medi-Cal Fraud and Elder Abuse for various home health agencies.
  • Litigation Defended home health agencies in litigation matters including licensure defense, payor and reimbursement disputes, overpayment appeals, business and employment defense, Medicare and Medi-Cal exclusions and suspensions by government entities including CMS, Office of the Inspector General, and California Department of Health Care Services.
  • Regulatory Defense Handled Department of Public Health (“DPH”) licensure investigations and appeals, reimbursement audits by private and governmental payors and their contractors, including CMS, Medicare, Medi-Cal and National Government Services, for several home health agencies.

Nelson Hardiman has a firm grasp on the complex Medicare regulations for hospice care providers. We leverage our understanding of these complicated reimbursement requirements to provide seamless counsel on the myriad legal issues involved in caring for terminally ill patients.

Our experienced team of healthcare attorneys has decades of experience in all aspects of long term care. The two biggest reasons why Nelson Hardiman defends Medicare recovery audits are inadequate understanding of Medicare coverage requirements and documentation practices. We tackle these issues up front, working with hospices and physicians to chart the very specific qualifying criteria and timing requirements for certification and re-certification. Nelson Hardiman steers a steady regulatory course for hospice care providers, skillfully navigating the dual goals of patient care and business operations.

Our Work Includes:

  • Audit Risk Assessment Reviewed the medical necessity of hospice claims, length of stays and number of nursing home patients, physician certifications and re-certifications to the audit risk for a hospice.
  • Business Formation, Structure and Contracts Advised on entity formation and business structure, professional and executive contracts, purchase and sale agreements, payor and vendor contracts, service, employment and independent contractor agreements for a hospice.
  • Compliance Handled licensing, operational, and reimbursement compliance, Medicare and Medi-Cal enrollment and enrollment errors, corrective action plans and other compliance strategies, prepayment review, licensure citations and deficiencies for various hospices.
  • Compliance with Hospice Cap Counseled on HIPAA and state patient data privacy and security requirements for several hospices.
  • Fraud and Abuse Investigations and Defense Managed and defended investigations by government payors and their contractors including Safeguard Services, Office of the Inspector General, Office of the Attorney General, U.S. Department of Justice, Department of Health Care Services, Bureau of Medi-Cal Fraud and Elder Abuse for several California hospices.
  • Local Coverage Advised on determination compliance and documenting medical necessity for skilled nursing services, physician certifications, and physician face-to-face encounters for a hospice.

Understanding the evolving healthcare industry and helping clients prepare for the looming “silver tsunami” empowers Nelson Hardiman to advise on senior services. Our focus on healthcare innovation and next generation healthcare provides a natural segue to today’s senior living facilities. We represent and counsel clients on business, regulatory and strategic challenges, helping senior services providers tackle regulatory hurdles, avoid disruption and financial distress, and tackle the shift in the competitive landscape towards new care alternatives.

Our healthcare team concentrates on the day-to-day operational concerns, demanding regulatory requirements, and project-focused business objectives of independent senior housing, continuing care retirement communities, and residential care facilities for the elderly. Whether our clients strive to sustain the financial viability of “all-in-one” senior living communities or seek alternative solutions to support seniors who want to “age in place,” Nelson Hardiman combines unique insight into the regulatory landscape and deep experience in healthcare finance to drive successful business operations and cultivate strategic growth for providers of senior services.

Our Work Includes:

  • Compliance Advised on licensing, operational, and reimbursement compliance, corrective action plans, audit risk assessment, local zoning regulations and the Fair Housing Act for the purchaser of a senior living facility in Southern California.
  • Contracts Negotiated payor contracts, service agreements and vendor contracts, employment and independent contractor agreements for a senior living facility in the lease-up phase of operations.
  • Entity Formation Advised on entity formation, corporate structures of all types ‒ LLCs, PLLCs, LPs, trusts, and non-profits ‒ together with governance documents to support regular business operations, financing, and mergers for numerous senior living facilities.
  • Financing Structures Advised on financing structures for senior living facilities and senior services companies, including collateralized, secured, unsecured, and credit swaps of various kinds, for bridge financings and other growth strategies for business owners and investors.
  • Litigation Defended licensure defense and appeals, payor and reimbursement disputes, and business and employment litigation for a senior living facility in connection with a change in ownership and management structure.
  • Regulatory Defense Represented Department of Social Services (“DSS”) licensure investigations and appeals, reimbursement audits by private and governmental payors and their contractors, and fraud and abuse investigations by government payors and their contractors for various senior living facilities.

Skilled nursing facilities (SNFs) depend on Nelson Hardiman for the legal experience to navigate the complex healthcare environment. From the acquisition and financing of SNF facilities to regulatory compliance programs and criminal investigations, we advise clients across all phases of the business cycle, as well as on complex financing, operational, regulatory and dispute matters.

We harness the minds, experience and specialized knowledge of our healthcare attorneys to grapple with the unique problems and legal concerns of skilled nursing facilities. SNFs serve a vital role in the continuum of long term care, challenged by the drive towards lower-cost, technologically-based solutions to deliver care and the high cost of providing such care in the increasingly value-driven healthcare industry. Nelson Hardiman helps skilled nursing facilities create regulatory pathways and savvy business plans to mitigate the conflicting pressures of regulation/operation and patient care.

Our Work Includes:

  • Acquisitions Negotiated major acquisition of SNF facilities by a national chain.
  • Criminal Defended a skilled nursing facility charged with involuntary manslaughter involving a patient death, resulting in dismissal of all criminal charges.
  • Drug Dispensing Advised on SNF pharmacy criteria for storing and dispensing drugs and biologics.
  • False Claims Act Defended False Claims Act lawsuit based on SNF marketer inducements to hospital discharge planners.
  • Insurance Back Fees Represented a SNF regarding almost $1 million in insurance back fees, negotiating with the Department of Health Care Services to create a payment plan.
  • Landlord/Tenant Successfully represented a SNF against a threatened lawsuit claiming hundreds of thousands of dollars in damages due to an unpaid Quality Assurance Fee. The multiple arguments in our response letter convinced the landlord not to take action and our client averted litigation and potential financial ruin.
  • Litigation Represented skilled nursing facilities in challenging federal and state criminal investigations and cases filed throughout the United States.
  • Regulatory Compliance. Counseled on all regulatory aspects of healthcare, including for skilled nursing facilities and related clients.
  • Regulatory Compliance Programs Developed and implemented regulatory compliance programs for over 100 skilled nursing facilities.
  • Stark/Anti-Kickback Statute Negotiated and implemented corporate integrity agreement on behalf of skilled nursing facility chain following a federal investigation of Stark/Anti-Kickback Statute violations.