Provider & Supplier Operations

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Full-Service Representation

Hooper, Lundy & Bookman’s provider operations practice represents hospitals, medical groups, home health agencies, hospices, HMOs, pharmacies, long term care providers, behavioral health care providers, DME providers, clinical laboratories, ambulatory surgery centers and individual practitioners nationwide in all aspects of provider licensing certification and accreditation, as well as medical staff policy, contracting, credentialing, bylaws and disputes. We also handle a full spectrum of operational issues involving consent and bioethics, electronic medical records and confidentiality of information. Our integrated practice allows us the flexibility to effectively serve clients in many capacities, from consultant to total program handling.

Our attorneys often serve as hearing officers on medical staff matters, and as members of bioethics panels. We also represent physicians in medical board disputes and represent providers in numerous other state and federal licensing issues. We have extensive experience in preparing and reviewing policies and procedures for peer review, quality assurance and risk management.

Cost-Effective Approach

We are proponents of a cost-effective preventive approach to handling these matters, which we address by providing clients representation in the form of education, bylaw-development and credential development. When problems arise, we make every attempt to resolve the issues before potentially costly formal steps must be taken.

Our attorneys regularly assist clients with a variety of licensing, Medicare and Medicaid certification and accreditation issues involving new programs and services, changes of ownership, compliance, and obtaining or preserving the provider-based status of various entities and programs.

Winning Enforcement Defense

When more aggressive actions are necessary, the firm represents providers across the health care spectrum in obtaining needed changes to licensure, Medicare, Medicaid and CHAMPUS certification and accreditation. With extensive experience at both the administrative agency level and in state and federal courts, we have successfully defended many clients against enforcement actions aimed at terminating or limiting licensure, as well as decertification. We also work with clients to protect scope of practice rights, and to facilitate changes in licensing and credentialing when it is in their favor. We have also successfully challenged many of the Centers for Medicare & Medicaid Services’ (CMS) attempts to impose civil monetary penalties for alleged certification and licensing deficiencies, including those for patient transfers.

Operations Specialties:

  • Initial licensure 
  • Surveys
  • Change filings
  • Addition filings
  • Enrollment and payment issues
  • Medicare and Medi-Cal audits and investigations
  • Provider-based status
  • Change of ownership
  • Advice, handling of accreditation survey issues and disputes
  • Bioethics, medical records and confidentiality issues
  • Defense and negotiation of Medicare/Medicaid certification termination and decertification
  • Defense of alleged patient transfer violations 
  • Dispute prevention counseling
  • Long-term care citation cases
  • Patient consent law, withdrawal of life support
  • Day to day operational compliance
  • Development of policies and procedures
  • Drafting plans of correction
  • Responding and reporting of adverse events 
  • Addressing scope of practice issues 
  • Defense of citations (immediate jeopardy and adverse events)
  • Drafting, reviewing and revising compliance plans

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For media assistance, please contact Maura Fisher at 202-580-7714.