Whiteford's Healthcare Law group advises healthcare entities (including managed care companies, hospitals, medical groups, e-health companies, insurance companies, pharmacy benefit managers, vision centers, practice management companies, ambulatory centers and other facilities) with respect to legal issues specific to the healthcare industry. Our Healthcare Law Group draws upon the diverse talents of attorneys firm-wide with experience in virtually every aspect of legal practice.
The Healthcare Law Group provides counsel on all aspects of health law ranging from fraud and abuse and corporate practice of medicine to government regulation and privacy. We counsel clients on HIPAA compliance as well as federal and state laws regulating managed care, Medicare and Medicaid. The Group also counsels and represents clients on matters related to compliance with anti-kickback statutes, self-referral legislation (the "Stark Law") and defending against False Claims Act actions. Our attorneys advise healthcare clients with respect to antitrust issues inherent in such matters as preferred provider organizations, joint venture arrangements and mergers and acquisitions.
In addition, the Healthcare Law Group provides guidance to insurance carriers and employers on health benefit plans. Our healthcare attorneys work closely with our Employee Benefits practice group to assist in the design of managed care mechanisms for employers and negotiations with direct contracting providers. Attorneys in the Healthcare Law Group routinely advise with respect to the laws relating to tax-exempt organizations and represent both tax-exempt organizations and for profit healthcare business in all types of business transactions, including, without limitation, joint ventures, mergers, corporate reorganizations, sales of business assets, stock or membership interests and numerous other types of transactions relating to or arising from the integrated delivery systems used to deliver healthcare services to the public.
Healthcare Litigation
Our Healthcare Litigation attorneys provide a wide array of litigation and consultative services to hospitals, pharmacy networks, physicians, dentists, HMOs, physician practice groups, nurses, mental health counselors, and nursing homes. These attorneys have defended practitioners, hospitals and healthcare groups in lawsuits before the Maryland Health Claims Arbitration Office and the federal and state trial courts throughout Maryland and the District of Columbia. The cases we are able to handle involve all healthcare specialties, including obstetrics and gynecology, neurosurgery, pediatrics, cardiothoracic surgery, transplant surgery, psychiatry, ophthalmology, oncology, radiology, urology, pathology, oral surgery, periodontics, prosthodontics, nursing, geriatric care, and physical therapy.
In addition, we provide risk management counseling services to clients. These services include lectures, mock trials, and other presentations to insurance carriers and individual insureds as well as to hospital risk managers and departments and hospital medical staffs.
Our attorneys also represent physicians, nurses, and other healthcare professionals in credentialing disputes and investigations and disciplinary actions before specialty boards. Our attorneys often are asked to assist physician groups and hospitals in formulating policies regarding retention and disclosure of medical records and other office practices that affect the potential risk/liability of the provider.
Providers continually struggle to get the fair reimbursement they deserve from payers and often feel powerless to negotiate better rates. However, regulatory changes aimed at increasing price transparency and prohibiting gag clauses have begun to produce movement in the provider’s favor.
On February 20, 2025, Virginia’s General Assembly voted to pass Virginia House Bill 2094, the “High-Risk Artificial Intelligence Developer and Deployer Act” (the “Act”). The Act is currently awaiting Governor Glenn Youngkin’s signature. If enacted, this legislation would become effective on July 1, 2026, and would be only the second of its kind among states thus far, second to Colorado. The Act aims to protect “consumers” from “algorithmic discrimination,” described as the “use of an artificial intelligence system that results in an unlawful differential treatment or impact that disfavors an individual or group of individuals on the basis of actual or perceived age, color, disability, ethnicity,” or other protected characteristics.
On March 15, 2025, President Trump signed into law a continuing resolution to fund the United States government for another six months, through September 30, 2025 (the “Continuing Resolution”). The Continuing Resolution includes extensions of applicable Medicare telehealth flexibilities through September 30 as well. Industry advocates continue to push lawmakers for a permanent extension of these flexibilities to help facilitate access to care for patients.
On March 10, 2025, the Centers for Medicare & Medicaid Services (“CMS”) announced a further delay in the implementation of proposed updates to its Guidance to Surveyors for Long-Term Care Facilities under Appendix PP of the CMS State Operations Manual (the “Guidance”). The March 10, 2025, announcement delays the implementation of updates to the Guidance until April 28, 2025. Proposed updates to the Guidance, originally issued on November 18, 2024 (with a proposed effective date of February 24, 2025), were the subject of a January 16, 2025, delay that pushed back the effective date to March 24, 2025. In its January 16, 2025 announcement, CMS proposed further updates to the Guidance, including with respect to ensuring sufficient staffing to meet resident needs (F725), allowing a Director of Nursing to fulfill the requirement for maintaining a registered nurse onsite eight consecutive hours per day/seven days per week (F727) and requiring surveyors to review a facility’s recent Payroll Base Journal data prior to survey (F851). Under the March 10, 2025, announcement, CMS maintained the same updates issued January 16, 2025, only making changes to the form documents attached to Appendix PP, to be used as part of the facility survey process.
Ambulatory Surgery Centers (ASCs) are experiencing significant shifts in regulation, reimbursement, and operational practices. These changes are driven by evolving healthcare policies, technological advancements, and the increasing preference for outpatient procedures. This article explores the current trends in ASCs, focusing on regulatory changes, reimbursement shifts, and revenue-sharing models. Additionally, it addresses compliance and legal concerns, specifically anti-kickback issues, and provides practical tips for maintaining compliance.
On January 23, 2025, the Fourth Circuit upheld an Advisory Opinion issued by the Office of the Inspector General for the Department of Health and Human Services (“OIG”) that found a proposed drug subsidization program could violate the Anti-Kickback Statute.
On November 20, 2024, the U.S. Department of Health & Human Services Office of the Inspector General (“OIG”) released its Nursing Facility Industry Segment-Specific Compliance Program Guidance (the “Nursing Facility ICPG”). The Nursing Facility ICPG provides analyses, discussion, and recommendations relating to compliance considerations for nursing facilities and supplements similar OIG guidance from 2000 and 2008. The Nursing Facility ICPG improves upon prior guidance by setting forth recommendations in a “user-friendly” format, with a discussion of more recent areas of focus for compliance (e.g., infection control, alternative Medicare reimbursement programs, etc.).
Value-based care (VBC) is a healthcare delivery model that prioritizes patient outcomes over the volume of services provided. This approach aims to enhance the quality of care while controlling costs by incentivizing healthcare providers to focus on delivering efficient, effective, and patient-centered care.
On January 16, 2025, the Centers for Medicare & Medicaid Services (“CMS”) announced revisions to its proposed updates to Appendix PP of the CMS State Operations Manual, originally released on November 18, 2024 (the “Guidance”). Significantly, the revised Guidance delays the effective date for changes to Appendix PP by one month, to March 24, 2025.
On December 20, 2024, the U.S. Department of Health & Human Services Office of the Inspector General (“OIG”) released a report (the “Report”) concerning purported failures on the part of skilled nursing facilities (“SNFs”) to properly disclose or account for “related-party costs” within their annual Medicare costs reports. The Report, entitled, “Some Selected Skilled Nursing Facilities Did Not Comply With Medicare Requirements for Reporting Related-Party Costs,” references an audit that examined how facilities reported costs among facility service providers. With respect to such service providers, the OIG found that, of fourteen facilities audited, three failed to disclose related-party relationships and seven failed to properly adjust for related-party costs in their Medicare cost reports.
On January 6, 2025, the U.S. Department of Health and Human Services (“DHHS”) Office of Civil Rights (“OCR”) published a proposed rule entitled, “HIPAA Security Rule to Strengthen the Cybersecurity of Electronic Health Regulation” (the “Proposed Rule”). The Proposed Rule aims to address extensive developments in the management, transmission, and protection of electronic protected health information (“ePHI”) that have arisen since the latest revisions to applicable HIPAA regulations in 2013. Such developments include the expansion of threats to the confidentiality, accessibility, and integrity of ePHI, including evolutions in malware, ransomware, social engineering scams, and other threats, as well as the increase in mobile devices that access and store ePHI, expanded use of remote/mobile workstations, and greater reliance on electronic and cloud-based data systems.
The Biden administration has signaled an intention to move ahead with publishing new, proposed requirements for Medicare/Medicaid-participating healthcare providers and suppliers in connection with emergency planning. However, with the upcoming change in presidential administrations, it is unclear whether, when, and to what extent any such updates may, in fact, be forthcoming.
With the end of 2024 and an expiration of applicable Medicare telehealth flexibilities approaching, Congress passed the American Relief Act of 2025, preserving applicable flexibilities for an additional three months, through March 31, 2025. This is a step back from the extension envisioned under a prior version of the same legislation, which would have extended flexibilities through the end of 2026. However, the legislation will help facilitate some relief from the impending coverage gap that may have resulted from failure to pass legislation extending the expiration of existing telehealth flexibilities beyond December 31, 2024.
On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the Medicare regulations interpreting the federal 60-day overpayment refund requirement (the Overpayment Statute) for Medicare Parts A and B as part of the Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule.
The IRS has recently been urging healthcare entities, particularly those involving physicians and private investors, to seek private letter rulings (PLRs) to clarify the tax implications of their ownership structures. This encouragement comes in light of the complexities and ambiguities surrounding the "friendly doctor" or "friendly PC" models, where a physician-owned professional corporation (PC) is managed by a separate management service organization (MSO).
In 2024, Stark Law enforcement remains a critical focus for healthcare providers and regulatory bodies, with a continued focus on excessive compensation and productivity bonuses. Compliance with Stark Law is essential to avoid significant penalties, including repayment obligations, civil monetary penalties, and potential exclusion from federal healthcare programs.
The California Department of Public Health (CDPH) issued a letter on September 6, 2024, to all general acute care hospitals clarifying the scope of practice for Certified Registered Nurse Anesthetists (CRNAs) following confusion and issues at hospitals in Modesto, California earlier this year.
The American Academy of Emergency Medicine Physician Group (AAEM-PG) recently settled a lawsuit in United States District Court for the Northern District of California against Envision Healthcare and Envision Physician Services, accusing them of violating the corporate practice of medicine (CPOM) laws in California.[1] The lawsuit alleged the “friendly physician” model used by Envision to control medical practices through management services agreements interfered with the medical judgment and autonomy of the medical entities Envision served. The model is commonly used in physician practice transactions with private equity investors.[2] The suit was unusual in that it was a private entity, not a government entity, requesting relief and asked the court to find models and those alike illegal in California.
The Department of Health and Human Services (HHS), in conjunction with the Centers for Medicare and Medicaid Services (CMS), is striving to alleviate the financial strain of medication costs on the elderly and disabled populations who rely on Medicare with the Medicare Prescription Drug Payment Plan. CMS has released final part two guidance for CY 2025 on July 16, 2024, to prepare stakeholders for its implementation.
For companies whose operations are subject to strict federal regulations – and particularly those that are facing or may be facing enforcement actions – take note. The U.S. Supreme Court may have just leveled the playing field. On Friday, June 28, 2024, the Supreme Court overturned a long-standing legal precedent that instructed courts to defer to federal agencies’ interpretations of ambiguous laws they administer. Instead, federal laws will be interpreted by the courts. Federal agencies will need to prove their cases, including enforcement actions where an arguably ambiguous statute is at issue. This is good news for businesses in the U.S.
The article provides an overview of the CMS Interoperability and Prior Authorization final rule and its implications for different types of providers. It summarizes the main requirements and deadlines for the rule, which aims to improve the efficiency and transparency of healthcare delivery by requiring the use of standardized APIs for data exchange among payers, providers, and patients.
The Federal Trade Commission (FTC) issued a final rule to amend its Health Breach Notification Rule (HBN Rule). The HBN Rule requires certain entities that handle unsecured personally identifiable health data to notify individuals, the FTC, and sometimes, the media of a breach of security.
On May 21, the Centers for Medicare and Medicaid Services (CMS) announced a new option on CMS.gov to allow individuals to more easily file an Emergency Medical Treatment and Labor Act (EMTALA) complaint.
On May 1, 2024, the U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), finalized a rule that prohibits discrimination on the basis of disability. This rule (“Final Rule”), titled Discrimination on the Basis of Disability in Health and Human Service Programs or Activities, more explicitly and specifically provides protections for people under Section 504 of the Rehabilitation Act (Section 504).
Even after a large amount of industry pushback, CMS issued the final rule for minimum staffing requirements and institutional payment transparency for long-term care (LTC) facilities. While stakeholders have indicated that the rule could put more pressure on current staff and lead to further workforce burnout, CMS insists the regulations are needed to ensure safety of the nation’s vulnerable populations.
Even after a large amount of industry pushback, CMS issued the final rule for minimum staffing requirements and institutional payment transparency for long-term care (LTC) facilities.
Centers for Medicare & Medicaid Service (CMS) revised hospital interpretive guidance in the State Operations Manual, Appendix A-Hospitals on April 1, 2024 in response to media stories of nation’s teaching hospitals and medical schools repeatedly performing sensitive examinations while under anesthesia without informed consent. Highlighted sensitive exams include but are not limited to pelvic, breast, prostate, and rectal examinations. The new guidance is effective immediately.
Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic authorization denials for tests that don’t match plan-determined diagnosis or that denied payment for post-acute care that exceed AI-predicted lengths of stays. The criticism has been that these decisions are not based on proper criteria or made in compliance with regulations.
The U.S. Attorney’s Office for the Eastern District of Pennsylvania recently announced that it had reached a settlement with Cigna Group (Cigna) to resolve allegations that Cigna had violated the False Claims Act.
In its recent ruling in U.S. v. Hathaway, the Sixth Circuit Court of Appeals provided additional authority that will be welcome to parties defending False Claims Act (“FCA”) matters based on the Anti-Kickback Statute (“AKS”).
The Court addressed two key points. First, it held that a violation of the AKS must be based on the payment of money or actual transfer of something of value. Second, it held that to prove a violation of the FCA, a relator must demonstrate but-for causation. In doing so, the Sixth Circuit has added another defendant-friendly ruling to the existing, and perhaps growing, circuit split.
Each year the Maryland Legislature enacts a number of laws which impact, in varying degrees, on the personal and business lives of people living in or doing business in the State of Maryland. The General Assembly adjourned on April 7, 2003, and the Session actively concluded when the Governor enacted legislation into State law during four separate signing ceremonies on April 8, April 22, May 13 and May 22, 2003.
The General Assembly adjourned on April 7, 2003 and the Session actively concluded when the Governor enacted legislation into State law during four separate signing ceremonies on April 8, April 22, May 13 and May 22. This year, as has been the case for the past several years, the Maryland Legislature was particularly active in the health care arena. The Legislature passed, and the Governor signed, a substantial number of important health care laws.
Health Occupations – Maryland Optometry Act – Replacement Contact Lenses – Clarifications and Modifications (SB 387) (10/01/03) - Prohibits a person from knowingly selling or dispensing contact lenses or replacement contact lenses without a valid and unexpired prescription or replacement contact lens prescription. A person who violates any provision shall be guilty of a misdemeanor and, on conviction, subject to a fine not exceeding $1,000.
Each year the Maryland Legislature enacts a number of laws which impact in various degrees on the personal and business lives of people living in or doing business in the State of Maryland. The General Assembly adjourned on April 8, 2002, and the Session actively concluded when the Governor enacted legislation into State law during four separate signing ceremonies on April 9, April 25, May 6 and May 16.
This webinar highlights trending obstacles in healthcare recruitment, examines the legal considerations for mechanisms used to entice recruits, and provides practical tips for compliance with specific healthcare and employment laws.
Whiteford is pleased to announce that “Best Law Firms” has awarded the firm exemplary rankings for 2025. Twenty-two of the firm’s practices are ranked at the national level, and the firm’s Bankruptcy, Construction and Labor & Employment litigation practices have been recognized with national Tier 1 rankings.
Whiteford is pleased to announce that Chambers and Partners has once again ranked the firm highly in its 2024 list of leading firms and business lawyers.
87 lawyers from Whiteford, Taylor & Preston have been selected by their peers for inclusion in The Best Lawyers in America® 2024 (copyright 2023 by Woodward/White, Inc., of Aiken S.C.). New practice areas of recognition include CleanTech Law and Entertainment and Sports Law. The lawyers selected are based in the firm’s Delaware, Maryland, Pennsylvania, Virginia and Washington offices. Client comments are posted on the Best Lawyers website, at bestlawfirms.com.
Whiteford is pleased to announce that Chambers and Partners has once again ranked the firm highly in its 2023 list of leading firms and business lawyers.
Whiteford, Taylor and Preston is pleased to announce that U.S. News and World Report - Best Lawyers ® “Best Law Firms” has awarded the firm exemplary rankings for 2023.
Whiteford, Taylor & Preston is pleased to announce that Chambers and Partners has once again ranked the firm highly in its 2022 list of leading firms and business lawyers. This year’s recognition includes 29 attorneys in 14 practice areas at the National and State level.
Whiteford, Taylor and Preston is pleased to announce that U.S. News and World Report - Best Lawyers ® “Best Law Firms” has awarded the firm exemplary rankings for 2022. Twenty-one of the firm’s practices are ranked at the national level, and the firm’s bankruptcy and Construction Litigation practices have been recognized with national Tier 1 rankings. At the state level, new recognitions include Admiralty & Maritime Law, Nonprofit/Charities Law, Patent Law and Privacy and Data Security Law.
A record 75 lawyers from Whiteford, Taylor & Preston have been selected by their peers for inclusion in The Best Lawyers in America® 2022 (copyright 2021 by Woodward/White, Inc., of Aiken S.C.). The lawyers selected are based in the firm’s Delaware, Maryland, Pennsylvania, Virginia and Washington offices. Client comments are posted on the U.S. News & Best Lawyers web site, at bestlawfirms.com.
Whiteford, Taylor & Preston is pleased to announce that Chambers and Partners has once again ranked the firm highly in its 2021 list of leading firms and business lawyers. This year’s recognition includes 25 attorneys in 11 practice areas in 3 states and the District of Columbia.
A record 71 lawyers from Whiteford, Taylor & Preston have been selected by their peers for inclusion in The Best Lawyers in America® 2021 (copyright 2020 by Woodward/White, Inc., of Aiken S.C.). The lawyers selected are based in the firm’s Delaware, Maryland, Pennsylvania, Virginia and Washington offices. Client comments are posted on the U.S. News & Best Lawyers web site, at bestlawfirms.com.
Whiteford, Taylor & Preston is pleased to announce that Chambers and Partners has once again ranked the firm highly in its 2020 list of leading firms and business lawyers. This year’s recognition includes 23 attorneys in 10 practice areas in 3 states and the District of Columbia.
Whiteford, Taylor and Preston is pleased to announce that U.S. News and World Report - Best Lawyers ® “Best Law Firms” has awarded the firm exemplary rankings for 2020. Twenty of the firm’s practices are ranked at the national level, including two bankruptcy practices with national Tier 1 rankings. At the state level, an additional forty-two practices have been ranked in Maryland, Washington, D.C., and VA.
64 lawyers from Whiteford, Taylor & Preston have been selected by their peers for inclusion in The Best Lawyers in America® 2020. The lawyers selected are based in the firm’s Delaware, Maryland, Pennsylvania, Virginia and Washington offices. Client comments are posted on the U.S. News & Best Lawyers web site, at bestlawfirms.com.
Whiteford, Taylor & Preston is pleased to announce that Chambers and Partners has once again ranked the firm highly in its 2019 list of leading firms and business lawyers.
Whiteford, Taylor & Preston is pleased to announce that U.S. News and World Report - Best Lawyers ® “Best Law Firms” has awarded the firm exemplary rankings for 2019. Eighteen of the firm’s practices are ranked at the national level, including two practices with national Tier 1 rankings: Litigation and Bankruptcy. At the state level, an additional forty-six practices have been ranked in Maryland, Washington, D.C., and VA.
Whiteford, Taylor & Preston is pleased to announce that Chambers and Partners has once again ranked the firm highly in its 2018 list of leading firms and business lawyers. This year’s recognition includes 29 attorneys in a record 12 practice areas in 4 states, the District of Columbia and Afghanistan.
Baltimore – Whiteford, Taylor & Preston is pleased to announce that U.S. News and World Report - Best Lawyers ® “Best Law Firms” has awarded the firm exemplary rankings for 2018. Nineteen of the firm’s practices are ranked at the national level, including three practices with national Tier 1 rankings: Litigation, Bankruptcy and Real Estate. At the state level, an additional fifty practices have been ranked in Maryland, Washington, D.C., and VA.
Whiteford, Taylor & Preston is pleased to announce that Chambers and Partners has once again ranked the firm highly in its 2017 list of leading firms and business lawyers. This year’s recognition includes a record 29 attorneys in 4 states, the District of Columbia and Afghanistan.
Whiteford Taylor & Preston announced today that prominent Maryland health care attorney Sigrid C. Haines has joined the firm as a partner in its Columbia and Baltimore offices. With decades of experience in health care and elder law, Ms. Haines is experienced representing hospitals, medical and health-related foundations, health care systems, nursing homes, home health agencies, physicians and pharmacies.
Whiteford, Taylor & Preston is pleased to announce that 41 of its attorneys are listed among the 2017 Super Lawyers and Rising Stars in Maryland and Kentucky joining the sixteen who were listed earlier this year in Delaware, D.C., Pennsylvania and Virginia.
Whiteford, Taylor & Preston is pleased to announce that, in addition to ranking the firm highly in its 2016 list of Maryland’s leading firms and business lawyers, Chambers and Partners have added new Whiteford lawyers in Maryland and Delaware.
The practice group rankings are based on the high rankings of 21 individual lawyers.
Fifty-nine lawyers from Whiteford, Taylor & Preston have been selected by their peers for inclusion in The Best Lawyers in America® 2016 (copyright 2015 by Woodward/White, Inc., of Aiken S.C.). The lawyers selected are based in the firm’s Maryland, Washington and Virginia offices.
Whiteford Taylor & Preston LLP is very gratified to announce that the firm has once again received exemplary ratings in the fifth annual U.S. News & World Report rankings of law firms.
Whiteford Taylor & Preston LLP is very gratified to announce that the firm has received exemplary ratings in the second annual U.S. News & World Report rankings of law firms. In Maryland, WTP was rated highly in 34 practice areas, more than any other firm in the state.
You may share a link to this page on any of the sites listed below.Send link by email
