Open Nav Close Nav

Long-term Facilities

The long-term care industry faces enormous challenges that are likely to increase in the coming decades:  growing demand for services as the population ages, shrinking reimbursement and a need to deal with higher levels of acuity with lower levels of care support. In this environment, Fenton Law Group’s team of attorneys offer deep experience in a range of regulatory and business challenges. We provide a full spectrum of legal services to long-term care providers. Our clients include skilled nursing facilities, assisted living facilities, home health agencies, hospices, senior residential providers, and many other long-term care niches.

We have dealt with every imaginable issue that arises in long-term care contexts, from licensing to operations to reimbursement. From defense of investigations to advice on day-to-day compliance to representation in litigation and complex transactions, Fenton Law Group works with large and small long-term care providers in all aspects of their businesses. Our experienced team of attorneys understands the nuances of the long-term care industry and has a long history of success advising long-term care providers before regulatory boards, in government audits, and in transactional matters.

Expand

Skilled Nursing/Post-Acute

Fenton Law Group represents California skilled nursing facilities in their business, regulatory, and strategic challenges, including:

Business Transactions

  • Formation of entities and business structure
  • Network and physician contracts
  • Negotiation of payor contracts
  • Purchase and sale agreements
  • Service agreements and vendor contracts
    • Ambulance companies
    • Durable medical equipment companies
    • Pharmacies
  • Employment and independent contractor agreements

Regulatory Defense

  • Department of Public Health (“DPH”) licensure investigations
  • Reimbursement audits by private and governmental payors and their contractors
    • CMS
    • Medicare
    • Medi-Cal
    • Palmetto GBA
  • Fraud and abuse investigations by government payors and their contractors
    • Safeguard Services
    • Office of Inspector General
    • Federal Bureau of Investigations
    • Department of Justice
    • Department of Health Care Services
    • Bureau of Medi-Cal Fraud and Elder Abuse
  • Audit defense
    • Zone Program Integrity Contractor (“ZPIC”)
    • Recovery Audit Contractor (“RAC”)
    •  Program Integrity Safeguard (“PSC”)

Compliance

  • Licensing, operational, and reimbursement compliance
  • Medicare and Medi-Cal enrollment and changes of ownership
  • HIPAA and state patient data privacy and security requirements
  • Regulatory audits and corrective action plans
    • Licensure citations and deficiencies
    • Medicare and Medi-Cal regulations
    • Prepayment review
  • Local Coverage Determination compliance and medical necessity audits
    • Skilled nursing services
    • Rehabilitation therapy services
    • Psychiatric diagnoses
  • False Claims Act compliance audits and solutions for marketing and business development activities

Litigation

  • Provider enrollment and claims appeals
  • Overpayment appeals
  • False Claims Act/qui tam whistle-blower litigation defense
  • Business and employment litigation
  • Exclusion and suspension appeals by government entities, including the Department of Health and Human Services Office of the Inspector General and California Department of Health Care Services
Expand

Assisted Living Facilities

Fenton Law Group represents residential care facilities for the elderly (RCFEs), also known as assisted living facility (ALFs) or board-and-care facilities in their legal business, regulatory, and strategic needs. Assisted living facilities offer seniors a residential setting that integrates assistance with various activities of daily living (ADLs), coordination of services by outside health care providers, and supervised resident activities intended to promote residents’ health, safety, and well-being. Growing numbers of assisted living facilities are experiencing challenges as the acuity of patient health issues increases, and as risks for elder abuse claims abound. Our experience in working with assisted living facilities includes:

Business Transactions

  • Formation of entities and development of business structure to support financing
  • Department of Social Services (DSS) license application requirements
  • Medi-Cal Assisted Living Waiver (ALW) program participation
  • Purchases and sales of assisted living facilities
  • Resident admissions contracts

Regulatory Defense

  • DSS investigations and hearings
  • Investigations by regulatory agencies

Compliance

  • Compliance with California licensing and operational requirements
  • Risk management in geriatric psychiatric care
  • Risk management in policies and procedures for assisted living facilities
    • Fall prevention
    • Physical and sexual abuse
    • Elopement/Failure to Supervise
    • Medication Errors
    • Change in Condition
    • Wound Care
  • HIPAA and state patient data privacy and security requirements

Litigation

  • Elder abuse
  • Business litigation, including shareholder disputes
Expand

Home Health Agencies

Fenton Law Group represents California home health agencies in their business, regulatory, and strategic challenges, including:

Business Transactions

  • Formation of entities and business structure
  • Negotiation of payor contracts
  • Purchase and sale agreements
  • Service agreements and vendor contracts
  • Employment and independent contractor agreements

Regulatory Defense

  • Department of Public Health (“DPH”) licensure investigations and appeals
  • Reimbursement audits by private and governmental payors and their contractors
    • CMS
    • Medicare
    • Medi-Cal
    • National Government Services
  • Fraud and abuse investigations by government payors and their contractors
    • Safeguard Services
    • Office of Inspector General
    • Federal Bureau of Investigations
    • Department of Justice
    • Department of Health Care Services
    • Bureau of Medi-Cal Fraud and Elder Abuse
  • Audit defense
    • Zone Program Integrity Contractor (“ZPIC”)
    • Recovery Audit Contractor (“RAC”)
    •  Program Integrity Safeguard (“PSC”)

Compliance

  • Licensing, operational, and reimbursement compliance
  • Medicare and Medi-Cal enrollment and changes of ownership
  • Corrective action plans and other compliance strategies
    • Prepayment review
    • Licensure citations and deficiencies
    • Medicare and Medi-Cal enrollment errors
  • Local Coverage Determination compliance and documenting medical necessity
    • Skilled nursing services
    • Rehabilitation services
    • Physician certifications
    • Physician face-to-face encounters
  • HIPAA and state patient data privacy and security requirements
  • False Claims Act compliance for marketing and business development activities

Litigation

  • Licensure defense and appeals
  • Medicare and Medi-Cal provider enrollment appeals
  • Payor and reimbursement disputes
  • Overpayment appeals
  • False Claims Act/qui tam whistle-blower litigation defense
  • Business litigation
  • Medicare and Medi-Cal exclusions and suspensions by government entities
    • CMS
    • Office of the Inspector General
    • California Department of Health Care Services
Expand

Senior Living

Fenton Law Group represents a variety of senior living facilities, including independent senior housing, continuing care retirement communities, and residential care facilities for the elderly. Fenton Law Group represents, counsels and assists senior living facilities with a wide range of business, regulatory, and strategic challenges, including:

Business Transactions

  • Formation of entities and business structure
  • Not for profit conversions and corporate governance
  • Purchase and sale agreements
  • Merger and acquisition due diligence
  • Negotiation of payor contracts
  • Service agreements and vendor contracts
  • Employment and independent contractor agreements

Regulatory Defense

  • Department of Social Services (“DSS”) licensure investigations and appeals
  • Reimbursement audits by private and governmental payors and their contractors
  • Fraud and abuse investigations by government payors and their contractors

Compliance

  • Licensing, operational, and reimbursement compliance
  • Corrective action plans
  • Audit risk assessment
  • Local Zoning Regulations
  • Fair Housing Act

Litigation

  • Licensure defense and appeals
  • Payor and reimbursement disputes
  • Business and employment litigation