Contract drafting, review, and negotiation, including major contracts with vendors and managed care payors

We routinely draft and review major contracts, and have conducted contract negotiations with major payors and other vendors, including Fortune 50 companies. We routinely draft or review physician employment contracts, management contracts, medical director contracts, clinical affiliation agreements, and managed care contracts, among others. For some of our hospital clients, we have provided model contracts suitable for use in specific situations (for example, employment, personal services, or space rental).

Advice concerning relationships with physicians and other practitioners, including compliance with the Stark and Medicare Anti-Kickback laws

We work closely with our clients to assure compliance in this highly technical area. By virtue of our close focus on health care, we often are in a position to assist in structuring complex relationships to meet these exacting regulatory requirements.

Advice concerning regulatory compliance, including licensure, certification, and participation in the Medicare and Medicaid programs

We routinely advise clients about these matters, and have represented hospitals (including Critical Access Hospitals) in matters involving Medicare certification, compliance investigations, and state licensure. We have assisted numerous hospitals in responding to emergent regulatory matters, such as alleged EMTALA violations or allegations of fraud and abuse.

Advice on employment matters, including immigration issues.

As difficulties with health care staffing increase, we increasingly are advising our clients on hiring, including immigration issues for foreign medical graduates and nurses. We also provide counsel on relationships with employees, assistance in investigations of sensitive matters such as allegations of sexual harassment, and terminations.

Guidance regarding antitrust and competitor relations

We have both counseled clients as to antitrust compliance, and represented them in connection with federal and state antitrust investigations and private antitrust claims. Through our extensive work on antitrust matters over the years, we have developed a collegial working relationship with both federal and state antitrust enforcement agencies, which continues to serve our clients' interests in current matters.

Advice regarding patient rights, including consent and confidentiality issues

We are on call 24/7 for our hospital clients in order to provide advice with regard to patient rights. For one of our hospital clients, starting with a late evening telephone call, we initiated a court proceeding to obtain an order for life-saving treatment; the hearing was conducted in the hospital at approximately midnight, and resulted in an order in favor of the hospital. More routinely, we have advised numerous clients on confidentiality issues, including implementation of the HIPAA Privacy Rule. Our clients have access to our attorneys' pager numbers, cell phones, and home telephone numbers, and we find it gratifying to answer emergent questions when our advice can really make a difference.

Assistance with planning and development matters, including Certificates of Need

We are actively involved in teaming with clients on health planning and strategic planning matters, including advice and representation on Certificates of Need. We are counsel to a consortium of hospitals in a Certificate of Need case that is currently on appeal to the Supreme Judicial Court of Maine.

Representation in connection with financing, including tax-exempt bond financing

We frequently represent clients in connection with financing, both tax-exempt and commercial. Our firm currently represents more clients in bond financings with the Maine Health and Higher Educational Facilities Authority than any other law firm. We estimate that the total amount of tax-exempt bond financing in which we have acted as borrower's counsel is currently approaching one billion dollars.

Guidance on federal and state tax exemption issues, including maintaining section 501(c) tax-exempt status

We have assisted numerous clients in obtaining and keeping tax-exempt status, especially in connection with complex corporate matters such as mergers, affiliations, and corporate restructurings, including preparing and filing applications for recognition of tax-exempt status under section 501(c)(3). We also have provided assistance in complying with IRS guidance on structuring joint ventures between tax-exempt hospitals and others.

Assistance with Medical Staff matters, including Medical Staff Bylaws and corrective action proceedings

We often advise hospitals and their medical staffs on drafting of Medical Staff bylaws and corrective action issues, and we have carried out a number of highly contested medical staff disciplinary proceedings and related litigation. We have also provided independent hearing officer services in such proceedings.

Advice regarding physician recruitments, including recruitment contracts and income guarantees

We frequently advise hospitals regarding permissible mechanisms for recruiting and retaining physicians, with an emphasis on developing workable long-term recruiting models for rural settings in compliance with section 501(c)(3) and Stark requirements.

Corporate law advice, including guidance to the Board of Trustees regarding compliance with fiduciary obligations

We frequently provide corporate law advice, including advice on fiduciary matters and nonprofit governance. Among other things, we have recently advised Boards of Trustees on compliance with those provisions of Sarbanes-Oxley that are applicable to nonprofit corporations, as well as conflict of interest, business judgment, and other fiduciary issues.

Assistance with financial and reimbursement matters, including payor relationships and collection of unpaid accounts

In addition to providing advice about reimbursement requirements, we frequently assist clients in securing payment of unpaid claims and accounts, both from third-party payors and from individuals.

Advice on health system integration, including network or physician-hospital organization formation and operation

We have assisted in the creation of numerous health care provider networks and physician-hospital organizations. For one client, we assisted in the restructuring of a physician-hospital organization that had been structured according to advice provided by a major national law firm.

Ongoing education of senior management, staff, Trustees, and the Medical Staff regarding significant health law issues

We regard education of our clients on the rapidly evolving health care legal environment as an integral part of our mission. Seminars, Board presentations, written informational materials, and update letters are all a part of the services that we provide in this regard.

Transactional advice, including purchases, mergers, acquisitions, and joint ventures

We have participated in numerous major transactions, including the consolidation of hospitals in neighboring communities to form the third-largest hospital in Maine; the affiliations of numerous independent providers, such as home health care agencies and mental health and substance abuse treatment service providers, with hospitals; the transfer of a small community hospital from one health care system to another; and technology joint ventures involving both hospitals and physicians.