Aging and disability providers do not enjoy the same independence as less regulated businesses. The hidden pitfalls found in complex payment or operational regulations may limit your options, thwart your goals or hamper your opportunities. Skilled nursing facilities, home health agencies, assisted living facilities, sub-acute transitional care units, medical equipment vendors and organizations providing supports for persons with developmental and other disabilities all share the challenge of delivering quality services in a tough regulatory environment. When state or federal agencies limit your options for progress, reduce your funding for services, or impose harsh sanctions or penalties for unexpected outcomes beyond your control, we can help. Perhaps you’ve received an order from Department of Human Services (DHS) imposing a conditional license, or you’ve learned that Centers for Medicare and Medicaid Services (CMS) and the Office of Health Facility Complaints (OHFC) are denying payment for new Medicare and Medicaid admissions to your facility. Whether defending your hard-earned reputation or advancing your mission, we help navigate complex regulatory systems so you may attain your maximum benefit. We help solve, or avoid, the unexpected and unwelcomed regulatory surprise that can sideline your mission.
Negative regulatory findings not only tarnish your reputation, they also expose you to heightened enforcement sanctions, such as decertification or being designated a Special Focus Facility. Our attorneys solve a variety of challenging regulatory issues facing providers serving seniors and persons with disabilities:
- By contesting maltreatment determination findings under the Minnesota Vulnerable Adults Act, we have reversed negative findings against our clients, even in cases involving unexpected death and serious injury.
- We have overcome career-ending disqualification orders threatened against key employees of our clients.
- We represent Medicaid and Medicare providers in major payment and funding disputes with CMS, DHS and other payors, including rate adjustment audit recoveries by DHS for skilled nursing facilities and mental health providers.
- We represent providers in challenges to CMS survey deficiency sanctions and findings, including Immediate Jeopardy findings, Civil Money Penalties and Denials of Payment for New Admissions.
- We represent Medicaid and Medicare providers in state IDRs, IIDRs and federal DAB appeals contesting Civil Money Penalties and other sanctions.
- We represent providers in contested case proceedings challenging post-payment review audits conducted by the DHS Office of Inspector General and the Surveillance and Integrity Review Section of DHS.
- We represent skilled nursing facilities in appeals by residents contesting their discharge notice.
- We dispute state orders for license revocations, conditional licenses, and individual licensing discipline.
- We either defend civil malpractice lawsuits as the lead litigators, or we consult with our client’s insurance defense attorneys to identify and inject applicable regulatory defenses into the litigation.
In addition to contesting negative regulatory enforcement actions, we help our clients advance major systemic change and maintain regulatory compliance:
Advancing Systematic Change
- We craft and launch declaratory judgment injunctive relief actions in federal or state court to challenge and enjoin funding cuts or similar unfavorable amendments to state and federal government programs.
- Through litigation and other initiatives, we stopped payment disruptions to providers arising from state government shutdowns.
- We help our clients formulate and implement written operational and corporate policies that not only comply with regulatory requirements, but also make common sense. Our clients routinely seek our advice on important interactions with state agencies, residents, consumers or staff, such as:
- Plans of Correction
- Personnel and operational policies
- Discharge or transfer notifications
- Internal maltreatment investigations
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