Healthcare and Hospital Law
Healthcare is one of the most complex, heavily regulated and rapidly changing industries in the United States. Effective representation of healthcare organizations and providers requires more than knowledge of the applicable law. It also requires familiarity with the operations of healthcare organizations and relationships within the industry. The Sutin Firm health law team comprises eight attorneys, two of whom (Deborah Mann and Jesse Hale) practice health law exclusively or primarily. A third, David Johnson, limits his practice to consulting on healthcare matters with his Sutin colleagues, providing a direct benefit to both clients and the Firm. Collectively, they have more than six decades of experience representing healthcare clients and have been recognized for their expertise by their peers and clients alike. Because David remains in a consultative role, he is able to expedite legal research and offer the Firm’s other lawyers access to his wealth of contacts within the health care law industry across the nation.
Our attorneys represent a wide array of healthcare clients, including the New Mexico Hospital Association, hospitals, physicians and medical practices, post-acute care providers, clinical laboratories, nursing homes, FQHCs and community clinics, imaging and ambulatory surgery centers, insurers, behavioral health providers, telemedicine providers, pharmacies and licensed healthcare providers of all types.
We provide legal services in the following areas of health law:
- Healthcare Business and Transactions
- Business formation and dissolution
- Corporate law and governance
- Hospital and corporate bylaws
- Fraud and Abuse/Government Investigations
- Defense of False Claims Act and Fraud Against Taxpayers Act actions
- Assistance with government investigations, audits, and requests for documents
- Advice on compliance with fraud and abuse laws
- Assistance with billing investigations, overpayments, and recoupments
- Regulatory and Administrative law
- Representation before state and federal regulatory agencies
- Regulatory appeals
- HIPAA, Privacy, Security breaches
- 42 CFR Part 2 (Drug and alcohol treatment confidentiality)
- Medical Staff Issues
- Privileges and credentialing
- Medical staff bylaws
- Healthcare Compliance
- Stark, Anti-Kickback advice
- Billing and reimbursement issues
- Healthcare Facility Operations
- Responding to facility surveys
- Healthcare Litigation
- Commercial litigation
- Payor-provider disputes
- Medical staff litigation
- Employment Law and Litigation
- Physician contracting, termination
- General employment matters
- Professional Licensure Issues
- Physician, PA, nursing (including NP, CNM, CRNA), dentist, psychologist, DOM, pharmacist, social worker, counselor)
- Bioethics, Public Health and Policy
- End of life decision-making
- Informed consent
- Behavioral Health Law
- Community Clinics and FQHCs
- Pharmacy and Drug Law
- Antitrust Law
- Taxation and Financing
Staying abreast of changes in health law practice can be a daunting task. In addition to reviewing topical articles, case reports and governmental guidance, we are actively engaged in professional organizations such as the American Bar Association Health Law Section, the American Health Lawyers’ Association and the Health Law Section of the New Mexico State Bar Association. Two of our members have served or currently serve in the leadership of the ABA Health Law Section. David Johnson is a past Chair of the Section and Jesse Hale is the current Co-Chair of the Section’s Membership Committee. Among the benefits of our involvement in professional organizations is the development of a statewide and national network of consultants and healthcare attorneys with special expertise in areas of importance to healthcare clients. Our attorneys are also frequent speakers at health law conferences as well as meetings of industry groups.
- We advise clients on how to comply with statutes and regulations, and represent clients in disputes involving credentialing and peer review proceedings, medical staff matters, fraud and abuse investigations, and day-to-day operational issues.
- We advise boards with respect to their expanding duties of oversight of healthcare organizations.
- We defend a wide variety of claims against providers, including wrongful death, malpractice, medical products and corporate negligence, EMTALA, HIPAA, unfair practices, and wrongful discharge claims brought by employees.
- We represent physicians with respect to employment contract issues and privileging and licensure problems and medical groups in managed care contract negotiations.
- We serve as counsel to the New Mexico Hospital Association.
- We advise clients on New Mexico tax issues specific to the healthcare industry, representing for-profit and nonprofit healthcare clients with tax planning and structuring, audit defense, administrative protests, refunds, tax credits and incentives.
- We assist hospitals, nursing homes and other healthcare entities in restructuring contracts to be more gross receipts tax efficient.
- We represent a large heathcare provider in litigation and arbitration relating to its healthcare insurer.
- We represent hospitals and nursing homes in identifying and claiming healthcare related New Mexico gross receipts tax deductions and credits.
- We represent nursing homes in filing for New Mexico tax incentives.
- We represent a large health insurance concern in defending against a class action in U.S. District Court.
- We represented a home health care facility in $15 million acquisition by venture capital fund.
- We serve as local counsel defending nursing homes in a number of cases.
- We successfully represented a large health insurance company in its appeal of a rate increase before the New Mexico Superintendent of Insurance.
Select healthcare litigation experience between insurer and provider (published cases):
- Lovelace Health System, Inc., d/b/a Lovelace Health Plan, a New Mexico Corporation vs. ABQ Health Partners, LLC, a Delaware Limited Liability Company, Second Judicial District Court Case No. D-202-CV-2012-09746 (filed in 2012) (Represented ABQ Health Partners, a subsidiary of DaVita HealthCare Partners, Inc.)
- Lovelace Health System. Inc., d/b/a Lovelace Health Plan, a New Mexico Corporation vs. ABQ Health Partners, LLC, a Delaware Limited Liability Company, before the American Arbitration Association Case, No. 76 187 Y 00205 12 TNM. (filed in 2012) (Represented ABQ Health Partners, a subsidiary of DaVita HealthCare Partners, Inc.)
Representative nursing home defense litigation (published cases):
- Cathy Chapman, as Personal Representative of the Estate of Edward Doyle Berryman, Deceased vs. THI of New Mexico at Hobbs Center, LLC, d/b/a Hobbs Health Care Center, a for profit corporation, Fifth Judicial District Court Case No. D-505-CV-2008-108 (Served as local counsel defending nursing home.)
- Edith Lucero, as Personal Representative of The Estate of Alfred Gonzales, Deceased, vs. St. Vincent Hospital; Silverstone Healthcare of Santa Fe, II, LLC d/b/a Casa Real; THI of New Mexico at Vida Encantada, LLC d/b/a Vida Encantada Nursing & Rehab; THI of New Mexico, LLC d/b/a Vida Encantada Nursing & Rehab, Fourth Judicial District Court Case No. D-412-CV-2008-00116 (Served as local counsel defending nursing home.)
- Consuelo Coca, as Personal Representative of the Wrongful Death Estate of Maria Guadalupe Pita Coca, Deceased, vs. THI of New Mexico at Vida Encantada, LLC, THI of New Mexico, LLC, THI of Baltimore, Inc., THI of Baltimore Management, LLC, Trans Health Management, Inc., Fundamental Long Term Care Holdings, LLC, William Chaltry, Administrator, IHS Acquisition No. 151, Inc., IHS Long Term Care, Inc., and Does 1 Through 10, Fourth Judicial District Court Case No. D-412-CV-2007-00607 (Served as local counsel defending nursing home.)
Anne P. Browne
Suzanne Wood Bruckner
Tina Muscarella Gooch
Jesse D. Hale
David H. Johnson
Deborah E. Mann
Jay D. Rosenblum
Benjamin E. Thomas