Health Law

Caplan and Earnest LLC has a national reputation as one of the leading health law firms in the Rocky Mountain region. Since the founding of the firm in 1969, the health law practice has been a significant part of the firm’s business.

Caplan and Earnest’s health law practice focuses on providers. Our clients are hospitals, ambulatory surgery centers, mental health centers, home health agencies, continuing care retirement communities, long term care facilities, managed care provider networks, health care management companies, and ancillary services providers. We represent many types of provider business entities, including physician practices, physical therapy providers, billing companies, nursing practices, and integrated health care groups of providers of traditional and alternative medicines. In addition, Caplan and Earnest LLC provides assistance to self-insured employers and associations in the development of health plans, managed care networks, and HIPAA and other regulatory compliance.

Practice Focus Areas

The Caplan and Earnest health law group’s services include:

• Healthcare business transactions: Strategic planning; reorganizations; tax planning; integrated delivery systems; LLC operating agreements; corporations; joint ventures; buy-in and buy-out agreements; business contracts; equipment leases; bylaws; sales/purchase contracts; license agreements; and many other operational matters

• Healthcare regulations: Fraud and abuse analysis; compliance with Medicare and Medicaid laws; Stark law guidance; Colorado fraud and abuse advice; False Claims Act guidance; EMTALA policies and compliance; provider licensure; HIPAA privacy and security analysis and implementation; accreditation and certification consultation

• Non-profit and tax exemption matters: Incorporation of non-profit corporations; IRS Form 1023 preparation; advice regarding inurement, excess benefit and intermediate sanctions; guidance regarding state and local tax matters; policy governance advice; governing board consultation; IRS Form 990 completion; fair market value determinations

• Compliance: Board policies and procedures; direction of payment practices audit; voluntary disclosure and return of overpayments;

• Health Law litigation: Peer review; medical staff credentialing; hearing officer services; medical practice ownership disputes; non-compete disputes; antitrust litigation; provider discipline before licensure boards; provider-payor managed care disputes; Medicare/Medicaid regulation disputes; employer-sponsored and insurance plan coverage disputes

• Employment: Physician recruitment agreements; employment agreements; medical director agreements; restrictive covenants; employment termination advice and litigation; OSHA compliance; deferred compensation analysis; union organizing response for providers

• Managed Care: Provider contracts, provider network antitrust compliance, development of provider networks for managed care organizations; managed care contract negotiations; development of self-insured health benefit networks; HIPAA privacy and security rule compliance

• Antitrust: Monopoly analysis and regulatory assistance; price fixing avoidance; association management; group purchasing; messenger model advice

• Health Information Technology and compliance: health information technology contracts; health information technology implementation; electronic medical records implementation

• Healthcare Reimbursement: Facility and physician reimbursement and payment issues; claims denial management; development of policies for payment compliance; FTC red flag regulations; chargemaster compliance

• Financing: Issuer’s counsel for revenue and government guaranteed bond financing transactions

• Quality and Patient Safety: Compliance with state and federal quality and patient safety regulations; policies for "never events;" Joint Commission compliance creation and contracting for Patient Safety Organizations;

• Ethics: Assistance and education for hospital ethics committees; education for hospital boards of directors; clinical research compliance

• Risk Management: Rapid response to disasters and emergency events; FTC red flag rule policies to prevent identity theft; preparation of pandemic and disaster plans

Caplan and Earnest’s broad experience and diverse client base allows the firm’s attorneys to pool information, resources and expertise so that legal services are provided efficiently, creatively, and cost effectively. We have a strong client focus resulting in lasting business relationships, and we are known as problem solvers where others have failed. We take time to learn our healthcare clients’ goals and priorities, and then apply our experience, judgement and expertise to accomplish our client objectives.

Quality Indicators

Caplan and Earnest’s health law attorneys are well known in the Rocky Mountain region and provide assistance to policy makers and associations. Three of our attorneys have served as president of the Colorado Bar Association’s Health Law Section. From these experiences we learn and influence the issues that are at the forefront of Rocky Mountain healthcare delivery. Our attorneys have served as members of advisory councils to the Colorado Division of Insurance, as well as on many health community boards, including:

• Mental Health Center of Boulder and Broomfield Counties

• Healthcare Financial Management Association – Colorado Chapter

• Center for Bioethics and Humanities - CU Denver and Health Sciences Center

• People’s Clinic of Boulder (now Clinica Campesina)

• Colorado Association of Homes and Services for the Aging

• National Legal Panel - American Association of Homes and Services for the Aging

• Golden West Retirement Community

• ClinicNet

• Colorado Lawyers’ Committee Healthcare Task Force

Our attorneys are also frequent speakers and have presented before associations such as HFMA, the Colorado Hospital Association, the Wyoming Hospital Association, the American Health Lawyers Association, Colorado Association of Homes and Services for the Aging, the Healthcare Compliance Association, Colorado Managed Care Contractors, and the ABA Health Law Section. Our attorneys were the authors of the 2004 edition of the Colorado Hospital Association’s Consent Manual.

Representative clients