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Our Health Care Practice

The healthcare industry is heavily regulated, and we recognize the need of providers to respond promptly, effectively, and efficiently to regulatory requirements and changes. Our attorneys and staff have extensive experience in regulatory matters, and we are committed to analyzing the rapidly changing regulatory environment and keeping our clients advised on regulatory changes affecting their operations. We are frequent lecturers at educational seminars on statutory and regulatory changes sponsored by healthcare trade associations and professional groups, and also participate in continuing education programs for healthcare professionals and attorneys on health law matters. Our firm also conducts its own seminars which are approved for continuing education credits through the National Continuing Education Review Service of the National Association of Boards of Examiners for Nursing Home Administrators, as well as the Pennsylvania State Board of Accountancy and the Pennsylvania Continuing Legal Education Board.

Click the tabs below for more information in each specific area.

  • Admissions Agreements
  • Assisted Living
  • Collections
  • Continuing Care Retirement Communities
  • Corporate Compliance
  • Guardianships
  • Insurance-Liability Defense
  • Litigation
  • Medicaid and Medicare Reimbursement Appeals
  • Real Estate Tax Exemption and Assessment
  • Sales and Acquisitions
  • Special or General Counsel
  • Survey and Enforcement
  • Employee Management Programs

Admissions Agreements

Admissions Packages

We’ve become aware that many of our clients’ admissions agreements are outdated or don’t protect the financial interests of their facilities. The overall effectiveness of your facility’s accounts receivable is founded upon the strength of your Admission Agreement forms. The Admissions Agreement is a contract when it is properly executed by all parties. A valid contract provides the nursing facility with certain rights under state and federal laws as a creditor and claimant. Thus, business office directors and staff must have a thorough understanding of several key components of the Admissions Agreement. I am sure that many of you will agree that most problems related to collecting on a delinquent account stem from weaknesses in a poorly drafted or completed Admissions Agreement. We would be happy to consult with you on how to most effectively modify your admissions agreements to ensure the highest potential for success in the event one of your accounts becomes delinquent. We are happy to provide consultation on a flat fee basis or at our usual hourly rates.

Assisted Living

Our Firm is counsel for assisted living providers and has worked closely with providers and government staff on the development of new laws and regulations for assisted living in Pennsylvania. Our Firm was formerly General Counsel for the Pennsylvania Assisted Living Association.

Collections and Management of Accounts Receivable

Our Firm provides collections and debt recovery services to our healthcare and commercial clients. Our specialized attorneys work directly with our clients to develop collection strategies, provide advice as to specific aging accounts, and take the appropriate courses of action to liquidate accounts receivable and recover outstanding debt. Our collections staff is experienced in creditors’ rights; civil litigation; debt collection laws; asset searches; and the diverse regulatory, contractual, and family-related issues that are common in healthcare and long-term care collections. Our attorneys are knowledgeable in the laws related to Medicaid, Medicare, Social Security, and other payer sources. Although our attorneys aggressively pursue these matters, we also engage in cost-benefit analysis to ensure collection efforts are cost-effective and timely. In sum, our collections staff provides a legal service that is not found at general collection agencies.

Continuing Care Retirement Communities

We recognize that CCRCs, as hybrid providers of a continuum of services, face legal and regulatory issues not confronted by free-standing, long-term care providers. Our attorneys can help a CCRC develop residency agreements and respond to a wide variety of legal challenges unique to CCRCs. Additionally, we are familiar with the regulatory framework of the Insurance Department and with its regulators. We can also assist in resolving the regulatory and structural issues related to developing a CCRC. Capozzi & Associates was also Counsel for the CCRC in the successful and precedent-setting Chapel Pointe case before the Pennsylvania Supreme Court. In that case the Supreme Court held that Chapel Pointe's CCRC was exempt from the payment of all real estate taxes beginning in 2001.

Corporate Compliance

Corporate Compliance Programs

Capozzi & Associates, P.C. is a leader in health care compliance, particularly in the long-term care field. The Firm began implementing compliance programs for its long-term care clients even before the Department of Health and Human Services' Office of Inspector General issued its voluntary Compliance Guidance for nursing facilities. Today, the Firm's leading edge approach remains intact because of its strong efforts to constantly seek out the newest and best practices in health care compliance in order to assist its clients in implementing those practices in a careful, cost effective manner. This proactive approach to health care compliance has kept Capozzi & Associates, P.C. and its clients ahead of the industry in establishing and maintaining effective compliance programs. While compliance traditionally involves billing issues, the Capozzi & Associates P.C. Compliance and Regulatory Affairs Practice Group takes a broad view of corporate compliance and remains available to assist the Firm's clients with compliance issues in practically all areas. These areas include Survey and Enforcement, Labor and Employment, Non-profit tax status, Clinical and Quality Assurance, and Admissions. "Conservative Compliance" is the buzzword to describe Capozzi & Associates P.C.'s approach to health care compliance. The Firm's focus is to aid its clients in avoiding compliance issues by instituting effective compliance policies, procedures, and training. When the inevitable compliance issues arise, the Firm assists its clients in developing conservative "low risk" solutions that focus on resolving the problem, while preventing the problem from recurring in the future.

Capozzi & Associates P.C. provide a full range of health care compliance services to its client, including:
  • Review of current compliance, including HIPAA Compliance
  • Development of compliance policies and procedures
  • Assistance in implementing and operating compliance programs
  • Development and review of compliance audits
  • Compliance dispute resolution
  • Compliance Training
  • Litigation with State and Federal Agencies, including the OIG.

Guardianships

Our Firm has developed a statewide guardianship practice and works with clients to obtain guardianships to protect residents and assure continuity of their care. Our Firm has developed relationships with guardianship services organizations that serve as guardians for residents who have no other relatives willing to do so, or for residents who need an independent guardian. Our Firm also has experience in coordinating guardianship proceedings with Medicaid eligibility determinations to assure continuity of Medicaid payments.

Insurance-Liability Defense

Our Firm will act as insurance defense counsel in nursing facility liability and malpractice cases, as well as other types of liability cases.

Litigation

Capozzi & Associates P.C. is committed to aggressively litigating disputes on behalf of its clients. While providing that representation, we remain conscious of the need to compromise where appropriate and when in the best interests of our client considering the uncertainty and cost of lawsuits both in terms of fees and the diversion of our clients' time and resources. Experienced litigators of the Firm counsel clients concerning these matters and assist them in weighing over-all business interests and objectives against the specific issues involved in any judicial proceeding. In matters where our clients have made a business decision to pursue a claim or where they have been forced to defend claims brought against them, our fundamental goal is to advise and assist our clients in making the most beneficial decisions.

The Firm's litigators have broad experience in representing clients in matters such as:
  • Claims relating to the sale, purchase and operation of businesses, including breach of contract, fraud, misrepresentation, breach of warranties and covenants, unfair competition, and restrictive covenants.
  • Representation of owners and businesses in construction industry litigation.
  • Defending employers in workers' compensation and unemployment compensation matters.
  • Proceedings before Federal and State regulatory and administrative agencies.
  • Defense of unionized employers in labor matters, including matters brought before the National Labor Relations Board.
  • Labor arbitrations brought by Unions and unionized employees in connection with an employer's collective bargaining agreements.
  • Defense of employers in matters before State and Federal Regulatory agencies as well as State and Federal Courts on discrimination charges such as those based on Title VII of the Civil Rights Act, ADEA, ADA, FMLA and Equal Pay

Medicaid and Medicare Reimbursement Appeals

Our attorneys have a proven and documented record of success in the litigation and resolution of Medicare and Medicaid reimbursement appeals. Our Firm has handled over 1,000 appeals brought by providers to increase Medicare and Medicaid reimbursement, including litigation before Federal Courts, the Commonwealth Court, and the Supreme Court of Pennsylvania. Capozzi & Associates P.C. has also handled numerous administrative appeals and regulatory matters in other states. While budgetary cuts at the State and Federal levels have resulted in efforts to reduce reimbursement to healthcare providers, our goal is to "level the playing field" and obtain payments for costs, care, and services to which our clients are legally entitled. Due to his experience in this field, Mr. Capozzi was appointed to serve on the Advisory Committee established to provide assistance and guidance to the Pennsylvania Department of Public Welfare in the development, modification, and continuing review of regulations for Pennsylvania's new Medicaid provider appeals process established by Act 142-2002. Mr. Capozzi also served as a Commissioner for the Senior Care and Services Commission. Our Firm also provides comments and suggested changes to proposed Federal and State regulations affecting our clients' Medicare and Medicaid reimbursement. Finally, our Firm, where necessary, will file petitions on behalf of our clients seeking exceptions and waivers of regulatory limits permitted by law.

Real Estate Tax Exemption and Assessment

Our Firm is also experienced in representing both nonprofit and for-profit providers in real estate tax assessment appeals in order to obtain exemptions or reductions in their real estate tax assessments, including the ability to litigate issues through the appeal process where an amicable resolution is impossible. Our firm is also experienced in assisting our nonprofit clients with developing compliance guidelines for preserving their tax exempt status. In addition, our Firm is experienced in obtaining exemptions from Federal and State sales and use taxes.

Sales and Acquisitions

Our Firm has acted as special or corporate counsel in numerous transactions, including acquisitions of facilities in bankruptcy. We work to structure transactions to enhance Medicare/Medicaid reimbursement and to streamline the regulatory approval process. We also advise clients on how best to address Union collective bargaining agreements which exist, including negotiating new agreements and eliminating exposure for the prior owner's past employment practices. During the week of July 1st, 2011, our Firm successfully closed over $30 million in sales involving our clients.

Special or General Counsel

Our Firm provides assistance with general and corporate issues which every business, including healthcare providers, must confront. We have assisted with restructuring some of our clients to better position themselves for the risks and challenges of the changing healthcare system, as well as to participate in joint ventures or to diminish the risk associated with expanding into new service areas. We also provide special assistance to our clients by updating existing policies and practices (including employee manuals), and to draft admissions agreements and other contracts that meet program and licensure requirements in addition to assisting with timely collections and the resolution of disputes. We also work with our clients on the development of home and community based service programs and strategic planning to consider the legal and business aspects of responding to the ever changing healthcare delivery system.

Survey and Enforcement

Our attorneys are familiar with the requirements for participation in Federal and State healthcare programs, and assist our clients with obtaining and maintaining required licensures and certifications while meeting compliance standards for those programs. We have assisted providers in developing effective healthcare policies and in responding to both State and Federal regulators. We have worked with our clients to successfully utilize the informal dispute resolution process. We recognize the sound business sense of resolving some survey disputes amicably without relinquishing the merits of the provider's position while preserving the provider's appeal rights. The broad experience we have gained from assisting providers through the compliance, survey, and enforcement process is available to our clients.

Employee Management Programs

Employee Handbooks
Capozzi & Associates can develop a comprehensive handbook tailored to your specific needs and train your staff to fully understand the requirements of employment at your facility.

Corporate Compliance Programs
The compliance services offered by Capozzi & Associates include development of policies and procedures tailored to your specific needs, identification of risk areas, implementation of employee training programs, and annual compliance reviews.

Admissions Packages
Capozzi & Associates can streamline your admissions process while ensuring that your facility is in compliance with required rules and regulations.

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