Our healthcare attorneys have depth and breadth of experience that is rooted in traditional healthcare issues and regulatory matters such as licensing, Medicare, Medicaid and commercial reimbursement issues, while continuing to grow our expertise as new innovations develop. The healthcare industry is undergoing fast-paced and dramatic change. Clients turn to Pierce Atwood as a trusted advisor during these disruptive times. We provide comprehensive legal and strategic advice to a wide range of sectors including hospitals, health systems, and medical groups; health technology companies; insurance companies; pharmaceutical companies; and post-acute care providers. Our team of trusted healthcare experts combined with our broad and deep experience in laws and regulations concerning corporate organization, mergers and acquisitions, finance, insurance, information technology, antitrust, and employment, among other areas, enables us to provide a full range of comprehensive services to assist clients in meeting the challenges of the current healthcare environment.
As new models of healthcare delivery evolve beyond the traditional in-person encounters, we provide counsel to clients on issues pertaining to health information technology, telemedicine, mobile health, and big data, as well as federal and state privacy and security laws including HIPAA.
As the marketplace continues to consolidate, we provide strategic and regulatory advice in conjunction with mergers and acquisitions. We have represented clients in hospital and medical practice transactions, guiding them through federal and state regulatory issues. Our regulatory expertise ensures clients’ needs are met in numerous areas such as federal and state fraud, waste, and abuse laws including anti-kickback, self-referral laws, and False Claims Act matters, licensing issues, reimbursement guidance, privacy and security matters under HIPAA and state law, Affordable Care Act and healthcare reform matters including the shift to value-based reimbursement, bond financing, and tax issues facing for-profit and not-for-profit healthcare companies.
We provide ongoing advice and counsel, including service as outside general counsel, to accountable care organizations participating in the Medicare Shared Savings Program, the Next Generation Accountable Care Organization model, and Medicaid and commercial accountable care arrangements. We draft and negotiate risk based contracts, and provide guidance on data use agreements for integrating clinical and claims data and strategizing population health initiatives. We provide counsel on network design and development and associated regulatory and compliance issues, and data privacy and security. We help clients navigate the regulatory hurdles that lurk in structuring new models of healthcare delivery.
We guide on alignment of managed care and value based reimbursement strategies, including Medicare Advantage, to enable providers to understand and navigate MACRA and commercial reimbursement strategies. Alternative payment models and the structural and operational changes traditional healthcare providers face require depth and breadth of legal expertise to navigate legal and strategic implications.
Pierce Atwood’s Healthcare Law Group can assist clients in understanding, complying with, and launching initiatives under the Patient Protection and Affordable Care Act of 2010 (ACA). The ACA imposes a myriad of requirements on states, hospitals, other healthcare providers, insurers, employers and individuals. It also creates initiatives to address healthcare effectiveness and costs, including the operation of accountable care organizations (ACOs) and health insurance exchanges.
Areas of Expertise
Antitrust Issues in Healthcare
We provide clients with antitrust counsel experienced in all aspects federal and state law applicable to the competitive issues that face healthcare clients. Our experience in mergers and acquisitions, federal and state investigations and reviews, information exchanges, contract restrictions, exclusionary practices, competitive relations and other matters of relevance to competition in healthcare is extensive.
We assist clients in competitive analysis of mergers and acquisitions, management of due diligence and pre-closing activities (including prevention of “gun jumping” activities), preparation of premerger notifications (HSR filings), and dealings with State Attorneys General (AGs), the Federal Trade Commission (FTC) and the Department of Justice (DOJ) in connection with the review and investigation of acquisitions. We also provide guidance to clients in connection with competitive issues relevant to the Maine Hospital Cooperation Act, certificates of need and conversion proceedings.
We have extensive experience in the wide variety of competition issues inherent in dealings with competitors, including limitations on the sharing of data and competitive information, joint venturing and joint purchasing arrangements and other types of collaborations among healthcare providers, exclusionary practices, industry trade associations and other activities.
We provide guidance concerning competitive issues associated with contract restrictions, exclusive dealing arrangements, “most favored nations” clauses, other vertical exclusionary practices and the improper exercise of market power.
We also assist clients in responding to civil and criminal investigations initiated by the DOJ, FTC, state AGs, and other regulatory entities into matters involving competition, including in responding to subpoenas for documents or depositions and representing clients who are the principal targets of investigations.
Employment, Labor & Benefits in Healthcare
Chest Medicine Associates
Down East Community Hospital
H.D. Goodall Hospital
MaineGeneral Medical Center
Martin's Point Health Care
MedEquity Capital, LLC
New England Cancer Specialists
Northern Maine Medical Center
Penobscot Valley Hospital
James R. Erwin (Employment)
Charles S. Einsiedler, Jr. (Benefits)
Pierce Atwood has been Maine’s leader in health care labor and employment for many years. We help health care and other clients manage the entire range of issues and risks associated with the employment relationship, such as protected class discrimination, harassment, whistleblower retaliation, failure to accommodate, leave management, wage-hour, defamation, confidentiality of patient and company information, hiring, drug testing, affirmative action plans, performance management, employee discipline and workforce reductions. We work with clients to develop prevention strategies, including in-house employment law training for managers and updates on developments. We defend claims in state and federal courts and in all administrative forums, including the Equal Employment Opportunity Commission, the Maine Human Rights Commission, the New Hampshire Commission for Human Rights, and the Massachusetts Commission Against Discrimination.
We advise a majority of the Maine hospitals that have collective bargaining units. We provide representation in contract negotiations, arbitrations, unit determinations and other Board proceedings, as well as regular advice and counsel on contract administration and compliance. At the same time, we have helped our non-union clients stay union-free.
We also work with a broad range of non-hospital providers in the industry, including home health agencies, long-term care facilities, physician practices, laboratory services, research institutions and insurers. We provide advice and representation to clients in connection with worker’s compensation laws and insurance, loss control, workplace safety and liability, compliance with OSHA requirements and administrative proceedings before the Maine Bureau of Insurance.
Our employee benefits team offers extensive expertise in the structure of executive compensation plans, and the design, implementation and termination of the broad range of employee welfare benefit plans. Because of our experience, we can offer a unique and balanced perspective on the provision of affordable benefit packages that maintain employee morale while complying with a myriad of federal and state laws, including COBRA, ERISA, HIPAA, GINA, the ACA and anti-discrimination laws.
Government Relations & Regulatory Counsel for Healthcare Clients
Pierce Atwood’s expertise in healthcare matters includes a robust legislative, administrative and regulatory practice. We represent a wide variety of healthcare providers and entities, as well as other businesses and industries that are affected by healthcare policy and regulation. Our experienced Government Relations team utilizes its substantive expertise, resources, and political savvy to provide clients with effective representation, whether active lobbying of legislation, advocacy before a regulatory agency, or routine monitoring of healthcare legislation and administrative proceedings.
Examples of the legislative issues in which we have engaged are health insurance regulation, Medicare and Medicaid issues, price transparency, scope of practice, provider reimbursement, fraud and abuse compliance, data collection and privacy, guaranteed access reinsurance, nonprofit conversions, Hospital Cooperation Act and pharmaceutical regulation.
We assist clients in the full range of regulatory matters, such as licensing and disciplinary proceedings, reimbursement-related rulemaking proceedings, fraud and abuse reporting and compliance, certificate of need applications, and numerous other regulatory matters. Our practice includes representation of clients in front of the Maine Department of Health & Human Services, the Maine Board of Pharmacy, the Maine Bureau of Insurance, the Maine Boards of Licensure in Medicine, Osteopathic Medicine and Nursing, and the Maine Workers Compensation Board, among others.
A principal member of our Government Relations team is veteran State House lawyer-lobbyist Ann R. Robinson, who recently served as General Counsel and Director of Government Affairs for Maine’s largest independent physician practice group that included two ambulatory surgical centers. Ann’s legislative expertise is deep and broad, encompassing decades of experience in lobbying on healthcare matters affecting physicians, pharmaceutical manufacturers, PBMs, mail-service pharmacies, and health insurance companies. In her regulatory practice, Ann has frequently appeared before the Maine Board of Pharmacy, state professional licensing boards, DHHS, and the Maine Bureau of Insurance. She has represented healthcare entities in licensing and enforcement proceedings, compliance matters, rulemaking proceedings and fraud and abuse compliance proceedings.
Another key member of our Government Relations team for healthcare matters is Andrea Cianchette Maker. Andrea’s past experience as the public affairs director for a substantial Maine-based healthcare provider organization provides a valuable perspective and expertise in healthcare advocacy for our clients.
Collectively, members of our Government Relations team bring a diverse set of skills and experience to bear on our clients’ legislative and regulatory needs.
Pierce Atwood uses its deep insurance experience to advise healthcare systems, insurers, providers, agencies and others in all aspects of health-related insurance, as the businesses of health insurance and healthcare providers continue to become more entwined.
Our attorneys have played leading roles in the fundamental changes in Maine’s health insurance landscape over the past two decades, including:
- Lead counsel to an association of pharmaceutical benefit management companies challenging Maine’s PBM law.
- Helped solve Maine’s historically challenging workers compensation problems when we took the lead in creating the Maine Employers Mutual Insurance Company (MEMIC), which now has assets of approximately $900 million, and for which we continue to serve as outside general counsel.
- Responsible for ground-floor organization of the Maine Guarantee Access Reinsurance Association (MGARA), and continue to serve as its legal counsel.
Healthcare Financing & Bonds
Pierce Atwood provides unique experience to healthcare institutions in the areas of public and private finance, tax exempt bond issuance, bank financing, capital markets, tax increment and new markets tax credit financing, and other financing mechanisms.
We have handled exempt financings for many of the hospitals in Maine, including through the Maine Health and Higher Education Facilities Authority. We have developed system-wide shared financing and funding arrangements for healthcare systems with multiple affiliates, and worked out a unique approach to debt service reserve funding for the issuance of $285 million in tax exempt healthcare system bonds.
Our extensive experience in conventional bank financing and in capital markets enables us to assist health care clients in structuring lending and equity arrangements to meet their capital and operating needs. We regularly work with underwriters in major financings and acquisitions, and our experience in municipal finance, tax increment financing, economic development and new markets tax credit financing allows us to structure other creative financing arrangements for our clients.
Healthcare Information Technology & Data Analysis
Contact: Peter Guffin
Information technology and data analysis are central to the operation of healthcare businesses today. Whether clients are acquiring and implementing electronic medical records systems, patient web portals or cloud-based services, or performing research and analysis using health care data, they are confronted with a variety of legal considerations. Many of our healthcare clients are on the forefront of deploying information technology, including one of the first (and largest) health information exchanges in the country using clinical data.
We provide healthcare clients with a broad range of expertise in software procurement and licensing, technology implementation, data use and research license agreements, technology collaborations and joint ventures, technology outsourcing arrangements, Internet issues, cloud-based services, protection of intellectual property rights and dispute resolution and litigation. We also have expertise regarding compliance with the requirements of E-SIGN (Electronic Signatures in Global and National Commerce Act) to ensure the validity and enforceability of electronic records and transactions.
Immigration Counsel for Healthcare Clients
Central Maine Healthcare
Down East Community Hospital
Houlton Regional Hospital
Maine Medical Center
Martin’s Point Health Care
For more than 25 years, we have provided comprehensive immigration services to healthcare organizations and healthcare professionals. We serve as general outside immigration counsel for more than a dozen healthcare organizations in New England, including Maine's largest healthcare organization, as well as healthcare organizations serving remote and rural HPSA/MUA communities.
Our immigration group partners with medical directors, human resources personnel, recruiters, in-house counsel, physicians, and other healthcare professionals in obtaining temporary and permanent visas. We have a substantial background in all work-related visa classifications and provide strategic guidance to healthcare clients at all stages of the employment relationship. Our experience working with healthcare clients on legal, regulatory and employment-related immigration issues allows us to provide strategic advice and cost-effective immigration solutions. Our applications account for a significant share of all Conrad 30 approvals in Maine and for virtually all of the Flex 5/Flex 10 approvals in Maine.
Litigation for Healthcare Clients
Pierce Atwood’s litigators have extensive experience in class actions, employment, whistleblower, qui tam, false claims act, discrimination and similar cases of particular interest to healthcare entities. We handle the broad range of commercial litigation, including contract and business disputes, tort claims, construction claims, technology, data breach, and intellectual property litigation. We also counsel clients and litigate insurance matters of all kinds, including coverage issues, liability, and damage quantification.
We assist clients in federal and state investigations concerning statutory and regulatory noncompliance, competition laws, white collar crime and environmental compliance.
Privacy & Data Security of Healthcare Information
Contact: Peter J. Guffin
We have extensive expertise advising clients as to the proper and secure handling of patient health information and other healthcare data. Our expertise includes privacy, data security and breach notification requirements under HIPAA and the HITECH Act, as well as state laws and regulations related to healthcare information. It also includes incident response, communications with governmental agencies, risk mitigation and litigation strategies.
To ensure that clients obtain the best practical advice on complex issues such as privacy policies, information safeguarding, record retention, data breach notification, e-discovery and other privacy and security issues, we have assembled a multi-disciplinary team with both legal and industry expertise. As a result we are able to combine our knowledge of the law in the areas of intellectual property, technology, healthcare, employment, and litigation with extensive experience in privacy and data security issues to help clients solve problems.
Taxation Matters for Healthcare Clients
Our Federal Income and State and Local Tax Groups provide healthcare clients with high-level, broad expertise in taxation matters.
Along with our Trusts and Estates Group, the Federal Tax Group provides counsel to tax-exempt healthcare organizations concerning all organizational and operational aspects of obtaining and maintaining federal tax-exempt and public charity status. We also advise clients concerning the potential taxation of unrelated business activities, tax inurement issues and “permissible healthcare related tax” matters. Along with our Employee Benefits Group, the Federal Tax Group provides guidance on the array of tax issues involved in compensation and benefits, deferred compensation, executive compensation and healthcare retirement benefits programs. Our federal tax lawyers also regularly work with transaction lawyers to structure mergers, acquisitions, spinoffs and reorganizations in the most tax-efficient manner possible.
Our State and Local Tax (SALT) Group provides assists healthcare clients in planning and disputes involving state and local real and personal property taxes, including exemption issues for hospitals and other entities, and sales, use and transaction taxes. For example, we have represented hospitals in preserving exempt property tax status where portions of facilities are used for for-profit purposes, and have resolved sales tax disputes involving equipment acquisition and leasing. We have also worked extensively to protect and promote the SALT interests of our clients at the Maine Legislature.
Members of the Federal Taxation and SALT Groups, often working with members of our Litigation Group, regularly handle contested tax matters before the IRS, state and local taxing entities, and state courts, U.S. District Courts and the U.S. Tax Court. We advise clients concerning IRS and state audits and appeals, working to develop strategies to resolve disputed matters where possible.