Health & Welfare Benefits

Experience

District 29, UMWA v. Royal Coal Company, 786 F.2d 588 (4Cir. 1985)

Case involved company's obligation to provide health benefits to retired and disabled miners after expiration of 1981 Wage Agreement when it ceased all active mining and did not execute 1984 Wage Agreement.

Co-Management Agreements

Represented subspecialty physician practices to craft the terms of co-management agreements with hospital systems under which the physician practices assumed responsibility to manage and administer the delivery of care throughout a service line and across multiple facilities. Agreements included negotiation of best practice protocols, terms for quality assurance reviews, staffing, and terms for compensation that satisfied federal and state physician self-referral and antikickback requirements.

Data Registry Agreement

Worked with a physician-hospital organization, and an independent physicians association affiliated with River Valley Pediatricians, to craft a patient data sharing arrangement with area hospitals and physicians to effect, through HealthBridge, a health information exchange, an agreement that allows for the exchange of digital data and electronic medical records for pediatric patients with asthma. The negotiations resulted in an agreement that complies with the relevant state and federal privacy issues and terms of various federal programs that fund programs to facilitate the electronic interchange of records and data.

Development and Implementation of Primary Care Coding Consulting Services to Integrated Healthcare Delivery Systems

Worked with a consulting organization that offers billing and coding training to primary care physicians, to develop the business model for providing coding training to physicians and non-physician staff members of integrated delivery systems so as to protect the intellectual property developed by the client while allowing its use by service recipients. Developed the template agreements with service recipients and assisted the client in successfully negotiating agreements with healthcare systems.

Health Benefit Plan Participating Provider Agreement Interpretation

Worked with a large hospital and care facility to negotiate and interpret health benefit plan participating provider agreement terms with large, third-party payers.

Recruitment Agreements

Worked with a large hospital and care facility in West Virginia to recruit physicians as hospital employees and as employees of community-based practices. Negotiated and drafted three-party agreements among the hospital, community-based physician groups and physicians that incorporated the desired terms of employment and financial assistance to community-based physician groups in a manner that satisfied the parties’ business needs and objectives while complying with federal and state regulations, including antikickback and physician self-referral regulations.

Revision and Restatement of Section 125 (Cafeteria) Plan

Consultation with client's legal and administrative personnel in connection with the redesign and restatement of this funding arrangement for health and welfare benefits for approximately 90,000 employees.

Services Agreements with Hospitals and Other Radiology Facility Service Providers

Worked with a national teleradiology company, in negotiating agreements with hospitals and ambulatory imaging centers throughout the country to provide the services of radiologists to interpret studies and to retain the services of radiologists. Agreements included employment terms and compliance with state and federal privacy, licensure, and Medicare and Medicaid enrollment and participation requirements.