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Health Care Law: The Health Care Section of Du Val Business Law is chaired by John Riherd, who most recently served as chief legal officer for The Regence Group, the holding company for Blue Cross and Blue Shield Plans in Oregon, Washington, Idaho and Utah.
John has over 30 years of experience in healthcare law, representing a wide variety of providers, including individual physicians, group practices, IPAs, HMOs, insurers and multi-specialty clinics.
John is supported in this practice section by Bill Du Val. Bill has built, purchased, sold and owned his own companies both within and without the field of law, giving him an entrepreneur’s perspective on owning and operating a professional corporation.
Their combined experience provides clients with the distinct advantage of being represented not merely by attorneys who understand the law, but who also have the practical experience and perspective that only comes by working in the world in which you work on a daily basis. Our health care practice focuses on physicians and the groups within which they work.
Here’s what we do:
Health Care Legal and Business Solutions
Physician Practice Management
Guidance to individual physicians, group practices, IPAs, multi-specialty clinics and other physician organizations concerning all aspects of the delivery of medical care including business formation, choice of entity, professional corporations, professional partnerships, joint ventures, and sole proprietorships.
Some of the specific areas include:
- the negotiation of individual employment or independent contractor professional services or medical director arrangements; to
- group practice participating provider agreements; and
- arrangements for ancillary services.
We assist Physicians in the resolution of billing and repayment disputes with third-party payors, including Medicare Part B carriers.
We represent individual practitioners in licensure and disciplinary matters, as well as credentialing and peer review issues with insurers and hospitals.
We provide assistance with the establishment and implementation of corporate compliance plans including patient safety and quality improvement plans.
We review and negotiate leasing space and equipment leasing arrangements, ancillary services arrangements, and other service contracts for state and federal self-referral and anti-kickback compliance.
Contracts With Insurers
Our Healthcare Section assists providers in the fine art of negotiating successful contracts with health care insurers and payors, focusing on the terms that are most important to physicians and other providers. Our experience with insurers helps to level the playing field for our clients.
Medical Staff Issues
The firm assists its clients with developing and implementing medical staff policies in accordance with laws, regulations, and standards. The firm also advises in peer review matters and medical staff appeals in accordance with fair hearing processes devised under the Healthcare Quality Improvement Act.
Provider Licensing, Certification & Accreditation
Our clients receive help with obtaining and maintaining appropriate licensure and certification by meeting the appropriate state or federal licensure requirements and/or conditions of participation.
Compliance & Fraud/Abuse Prevention & Defense
Physicians must assure that their operations are consistent with state and federal laws and regulations. The development of stringent, complex, and sometimes conflicting laws and regulations governing healthcare make proactive steps, such as the adoption of compliance plans, essential to all healthcare providers.
The firm assists its healthcare clients in developing compliance programs appropriate to their operations. Compliance programs consist of a number of important elements and must address the standards applicable to the particular healthcare provider, including such topics as Medicare and Medicaid billing, Medicare provider participation requirements, and health information privacy and security standards.
In addition, the firm provides its clients with guidance on structuring investments and transactions to comply with the various legal requirements governing those matters as well as guidance with respect to regulations governing proper documentation and billing for services. In doing so, the firm will consult with valuation and billing experts on behalf of its clients.
Medicare/Medicaid and Third Party Reimbursement
The firm provides its clients with assistance in determining the standards applicable to services reimbursed under state, federal and private healthcare programs. We also assist our clients in obtaining reimbursement through informal negotiations as well as through the administrative and legal processes. The firm resolves disputes relating to alleged Medicare and Medicaid overpayments. We assist our clients in pursuing administrative appeals, settlements, and repayment plans
Healthcare Business Transactions
DBL provides advice regarding the structuring and financing of healthcare transactions such as mergers, acquisitions and consolidations as well as more routine business arrangements with patients, facilities providers and third-party vendors.
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