Bryan successfully defended a Medicaid Managed Care Organization (MCO) in over 200 claims denial appeal procedures before Medicare Administrative Law Judges (ALJ) and the secretary of the Department of Human Services in Pennsylvania. He also developed reporting metrics and case-based training for the MCO to improve utilization review and quality review procedures, and to bolster compliance with various federal and state insurance regulations.

Our client, a nursing facility, was concerned that a project proposed by a competing facility would adversely affect their business. The competitor’s facility would have been less than a mile from our client, and the surrounding area already includes multiple nursing facilities. We successfully appealed the decision to grant a Certificate of Need (CON) to the competitor during an Ohio Department of Health administrative hearing.

We successfully represented a health system in connection with its certificate of need (CON) application to establish Primary Therapeutic Cardiac Catheterization (Primary PCI) services at its Beckley, West Virginia hospital. Primary PCI is a life-saving cardiac catheterization procedure offered to heart attack patients that this client was not able to offer at its southern West Virginia hospital without approval by the West Virginia Health Care Authority. We were successful in helping the client secure the CON following the administrative hearing and post-hearing brief.

Stacey has experience representing buyers and sellers in these types of transactions. Most recently Dinsmore represented a regional health system acquiring two specialty physician practices. We advised the client through all aspects of the transaction, including drafting and negotiating the asset purchase agreement, various management agreements, clinical services agreements, physician employment agreements, and affiliated real estate transactions.

Stacey completed a comprehensive effectiveness review of the enterprise’s compliance program and practices, from corporate governance, audit and monitoring, compliance education, communication and documentation, and corrective action plans. The review compared the enterprise’s policies, practices, and documentation to the OIG’s standards for an effective compliance program. The final report included recommendations and practical next steps for how to improve the enterprise’s overall compliance processes.

The 10^th District Court of Appeals reversed a decision of the Franklin County Court of Common Pleas, which affirmed the State Medical Board of Ohio and remanded the case back to the board for further proceedings. The court determined that the board did not act in accordance with law when it imposed a “stayed” license suspension without affording our client, a physician, an opportunity to be heard, and without determining the “threshold” question of whether, when the three day examination was ordered, the board had “reason to believe” the physician was impaired “because of habitual or excessive use of drugs or alcohol.” Upon remand by the court, the board chose to take no action against the physician and dismissed the case.

The Franklin County Court of Common Pleas reversed a decision of the State Medical Board of Ohio which suspended a physician assistant’s license after she tested positive on a single EtG test, notwithstanding four years of sobriety demonstrated through negative alcohol screens and direct monitoring from multiple physicians and the Ohio Physician’s Health Program. The court found placing primacy reliance on an EtG test is inappropriate and scientifically unsupported at this time, as the EtG test is highly sensitive to even inadvertent, low-level alcohol exposure, which can provide an unreliable result. The court found that the board erred by relying on the EtG test alone and reversed the decision of the board.

We served as bond counsel for Bon Secours Mercy Health, Inc., one of the nation’s 20 largest health care systems, with respect to the issuance of several series of bonds totaling $1.16 billion in aggregate principal amount. As bond counsel, we assisted with each step of the financing process, which involved the public offering of municipal tax-exempt and corporate taxable bonds involving issuers in three states. The bonds were issued in April of 2020 and enabled the financing or refinancing of health care facilities in Ohio, South Carolina, and Virginia while also contributing to the re-opening of the capital markets for health care borrowers during the COVID-19 pandemic. These combined bond deals were selected by The Bond Buyer as its 2020 Deal of the Year in the Health Care Financing Category.

After securing a provisional license to cultivate medicinal cannabis, our client sought to amend its original application plans after a local industrial park association retracted prior structural approval for facility plans. The Ohio Department of Commerce rejected proposed amendments to the applicant’s facility plans and moved to revoke the client’s provisional license. We negotiated with the association and the department and resolved the matter through revised structural plans that satisfied association bylaws, as well as other corrective actions and remedies approved by the department by way of a consent agreement and dismissal of the proposed revocation action. The client has since been granted a full license to cultivate and is successfully operating in northeast Ohio.

On behalf of a multi-office Ohio addiction treatment center, we handled the fraud and abuse investigation and subsequent negotiations with federal authorities who were reviewing the client’s receipt of free drug screening equipment from one of the largest laboratories in the country.  We successfully persuaded the United States Department of Justice to decline bringing criminal or civil charges, and the matter was eventually resolved with minor civil penalties paid to the United States Department of Health and Human Services / Office of Inspector General and avoidance of any administrative sanctions, including exclusion from participation in public health programs.

Our client, a marijuana cultivator applicant, submitted an application to the Ohio Department of Commerce seeking a provisional license to cultivate medicinal cannabis. The application process is extensive and applicants are graded against one another, with the top 12 companies selected for licensure. Despite scoring higher than six of the 12 companies granted licensure, the department notified our client it was proposing denying its application due to alleged deficiencies in its proposed security plan – one of five operational plans each applicant must satisfy. Through the administrative hearing process, we were able to demonstrate that a higher, corrected score for the security plan section was warranted, leading the department to reverse the proposed denial and instead grant our client’s application. This case represented the first successful administrative appeal by an applicant seeking a provisional cultivator’s license as a result of challenging its original score issued by the department.

We represented a health care services business that provided billing services to physicians groups and emergency rooms after a false claims act (FCA) suit was filed alleging the company had improperly coded and overcharged government health care services, including Medicare and Medicaid, by millions of dollars. We did our own analysis of the company’s records while working closely with the U.S. attorney’s office as well as the U.S. Department of Health and Human Services and found an explanation for the company’s coding and charges. As a result of our investigation no criminal charges were filed and the civil suit was not pursued.

When Hometown Urgent Care had an opportunity to sell a majority equity position to Ridgemont Capital, a top private equity firm, it turned to Dinsmore to advise on the transaction. We worked with the Ridgemont’s counsel to structure the transaction and negotiate the terms. Hometown and Ridgemont completed the sale in late May 2012. Hometown is one of the Midwest’s largest walk-in urgent care groups, with 25 locations spread across Ohio, Michigan and Kentucky at the time of the sale.

Successfully defended LabMD at trial before the FTC Chief Administrative Law Judge. LabMD is the medical laboratory whose data security policies, practices and procedures allegedly violated section 5 of the FTC Act. After a lengthy trial the Administrative Law Judge dismissed the complaint. This is a landmark case because it is the first instance in which the FTC has prosecuted a HIPAA “Covered Entity” for violation of consumer privacy without being joined by HHS. It is also the first instance in which the FTC has been forced to take a case to trial involving data security and privacy. Thus this case established the adjudicatory framework for FTC cyber security administrative trials including the standard of proof and elements required to prove section 5 consumer harm in a cyber security case.