"[Cadwalader's] key strength continues to be in the long-term care sector and it is a go-to name for a number of nursing homes"
- Chambers USA

The core expertise of our health care attorneys is their knowledge of the health care industry and the regulatory environment that shapes that industry.  In addition to having represented virtually every type of health care provider in the industry, the team has worked with investors in health care projects and institutional lenders to the health care industry, and has participated in the development of health care legislation and public policy at the state and national level.

As one of the first large law firms to develop a dedicated health care practice, for more than 30 years, we have offered counsel regarding general health care and insurance licensure and compliance issues, health care technology issues, equipment sales and leasing, general corporate organizational and reorganizational issues, mergers and acquisitions, joint ventures, initial public offerings, health care financing, securitization of receivables, reimbursement, contracts with hospitals and clinics, and general commercial and transactional matters. 

Our areas of expertise include the following: 

Internet: The Federal government and states are working to advance health information exchange by promoting interoperable health technology tools.  As this area evolves, including e-health record exceptions, safe harbors to the federal Stark law, implementation of health record systems, and new e-prescribing systems, we will assist our clients in understanding and taking full advantage of technological developments while complying with existing federal and state laws. 

HIPAA: The federal government’s adoption of privacy and security measures, through HIPAA and other initiatives, as well as the enactment of state health care privacy laws, has required many industry players to implement medical record and internet privacy and security policies.  In this area, our range of services includes interpreting relevant laws and regulations, assisting clients in structuring internal compliance programs and policies, structuring patient consents to facilitate health information exchange, handling data breach notifications, training employees, and designing other preventive measures to limit liability and protect against reasonably anticipated integrity breaches. 

Licensing, Accreditation, and Regulatory Oversight:  Our health care lawyers assist clients at every stage of their business life, from establishment and initial filing of a certificate-of-need application through licensing and beyond.  We represent providers in connection with licensing surveys by state health departments, as well as resolving deficiencies, problems with inadequate patient care, and dealing with any attendant adverse publicity.  We also represent health insurers and managed care plans in surveys and reviews by insurance departments, investigations by state attorneys general, and similar matters.  With a high level of recognition and credibility with state regulators, we also advise in connection with licensure and accreditation matters, including establishment applications, renewals, delicensure, and the resolution of related disputes. We also work to protect our clients from circumvention schemes that have prompted investigation and enforcement actions by regulatory authorities as well as civil suits by defrauded insurers.

Corporate Practice & Fee Splitting: Prohibitions on the corporate practice of medicine and fee-splitting by licensed professionals continue to complicate many health care initiatives and ventures.  Our health care attorneys have successfully steered numerous clients through business arrangements that meet their needs while complying with applicable law.

Medical Research: Our group has comprehensive experience counseling university hospitals, medical schools and foundations on the rights of those participating in human subject research, the disclosures required, and protecting the institutions and researchers conducting medical research. 

Provider Contracts with Insurers/HMOs:  We have long been involved in negotiating and drafting fee-for-service, managed care, risk-based and capitation contracts and know how to negotiate and arrive at the most beneficial risk and non-risk contracts, from negotiation through performance and in related disputes. 

General Counsel Services:  We work with each health care organization we represent to address its unique legal needs and issues, from general legal counseling and representation, to advice in important areas such as corporate governance; government licensing and regulation; JCAHO accreditation as well as accreditation of any teaching programs; Medicare, Medicaid and third party reimbursement; fraud and abuse; competitive strategies; medical care quality; tax issues; pension benefits; and many others.

Medicare & Medicaid/Third Party Reimbursement:  Our attorneys counsel clients on all manner of critical Medicare and Medicaid compliance and reimbursement issues, including state and federal regulations, rate appeals, third party audits, lawsuits, other proceedings, and every kind of payment issue.

Fraud and Abuse: Cadwalader has been at the forefront of developing and implementing comprehensive and cost-effective internal compliance programs.  We also provide our clients with criminal and civil defense, and representation in government audits and investigations, false claims, and qui tam (whistleblower) actions. 

Anti-Kickback Law:  Our attorneys have years of experience in matters implicating federal and state anti-kickback statutes—e.g., physician employment contracts, equipment and space lease agreements and patient referral arrangements—and routinely counsel providers and others in these potentially troublesome transactions.

Stark Law Compliance: Our team advises providers in structuring their business transactions to comply with complex state and federal laws and regulations prohibiting “self-referral” arrangements. 

Health Insurer Representation: With the increasing governmental focus on health care fraud, insurers must proactively integrate comprehensive anti-fraud measures within their business strategies.  Our team is particularly experienced in helping insurers deal with fraudulent schemes, helping to recoup client losses and develop effective programs to identify and reject fraudulent or improper claims.  We also work closely with legislators and regulators to assist them in understanding the scope of this problem, and in removing obstacles to effective anti-fraud measures. We also assist insurers with regulatory compliance; ensure that those with contracts to act as intermediaries or carriers for Medicare, or to run a Medicaid HMO, avoid misuse of government funds they distribute; help non-profit plans convert to for-profit status; and handle mergers and acquisitions.

Financings: Members of our team are experienced in representing lenders, underwriters, and borrowers in the public and private financing of health care organizations.  We counsel industry players in all types of structured financings and securitizations, and have handled significant IPOs and other public offerings for new technology and biotechnology concerns that develop processes and applications of use to the health care industry. 

Our attorneys not only routinely attend health care seminars and state and federal legislative hearings (and subcommittee meetings, where decisions are often made), but, as industry leaders, are frequently called upon as speakers and conference chairs and to testify on health care related issues.  We regularly monitor court and administrative agency decisions and legislative, regulatory, and union developments and brief our clients on current legal and business consequences.