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Poyner & Spruill LLP has a multi-faceted health care practice, representing a wide variety of health care providers on an extensive range of issues.  The Health Care Practice Group is composed of attorneys with extensive experience in every aspect of health law and with in-depth knowledge of current industry developments and issues.  The Group is committed to meeting the needs of health care clients in every facet of their business.  In addition to health care experience, Poyner & Spruill offers clients the advantages of a multi-disciplinary business firm, with supporting legal counsel available in the areas of corporate, tax, public finance, employment, employee benefits, and real estate.  

The Health Care Practice Group represents and counsels a full range of health care providers and practitioners, including:  hospitals and health systems, physicians and other medical professionals, physician practices, managed care organizations, provider associations, nursing homes, home health agencies, long term care facilities, intermediate care facilities, cancer treatment centers, providers of mental health and substance abuse treatment services, and ambulatory surgery facilities.  The breadth of the Group's experience encompasses state and federal regulatory and compliance issues, administrative dispute resolution and administrative appeals, state and federal civil litigation, rulemaking, operational and transactional matters, restructuring, joint ventures, integrated delivery systems, managed care, provider credentialing, peer review, medical staff issues, employment, and recruiting.  Our health care team has extensive experience in working with federal and state administrative departments and agencies, as well as fiscal intermediaries, carriers and insurers on a wide range of regulatory issues.  The Group assists clients in developing and providing practical, customized and forward-looking strategies for compliance with state and federal laws and regulations pertaining to Medicare, Medicaid, fraud and abuse, E-Health and HIPAA, certificate of need, patient/resident rights, and state licensing, administration and insurance requirements.   

Major Practice Areas:

• Administrative and Civil Dispute Resolution, Civil Litigation, and Appeals

• Business Transactions Involving the Full Spectrum of Health Care Organizations

• Provider Administration/Operations and Compliance

• E-Health and HIPAA Compliance Issues

• Legislative and Regulatory Issues

• Provider Credentialing and Peer Review

Christopher P. Brewer

Administrative and Civil Dispute Resolution, Civil Litigation, and Appeals

The Health Care Practice Group provides comprehensive services in administrative and civil dispute resolution, civil litigation, and appeals.  Led by Tom West, who served as a North Carolina Administrative Law Judge for 11 years prior to joining the firm, and Bill Shenton, who has counseled health care providers in North Carolina administrative dispute resolution, litigation and appeals for more than 15 years, our health care team offers clients a unique depth of experience in administrative legal matters.  Lee Spinks, who has more than 18 years of experience representing health care providers, represents providers in a full range of civil dispute resolution and litigation.  The Group assists clients in a full spectrum of administrative and civil matters, including:

• Certificate of need litigation and appeals

• State agency and department regulations and policies

• State licensure requirements

• Claims in state and federal court

 Recent illustrative experience includes:

• Representing hospital system in dispute with county board of commissioners regarding whether county had right to replace hospital system's board of directors

• Representing nursing home and dialysis providers in certificate of need appeals up to North Carolina Court of Appeals and North Carolina Supreme Court

• Resolution of contested certificate of need matters, both among competitive applicants and among applicant clients and Division of Facility Services

• Assisting home health care association in presenting data from numerous home infusion providers to Division of Medical Assistance to support providers' campaign to adjust reimbursement methodology to reasonably compensate for services provided, addressing antitrust aspects of providers' collective effort, and determining strategies for ongoing dialogue with DMA on this issue

• Assisting home health care provider in preparing form agreements with contract nursing providers that address state licensure and Medicare compliance issues

• Representing network of adult care homes in addressing compliance issues and working with state agency to negotiate acceptable plan of correction

Louis B. Meyer III

Charles F. Powers III

Steven Mansfield Shaber

William R. Shenton

Lee A. Spinks

Thomas R. West

Business Transactions

The Health Care Practice Group provides a full range of services relating to business transactions, supported by the firm's multidisciplinary corporate resources, including legal sections focusing in the areas of corporate, tax, public finance, employment, employee benefits, and real estate.  In the Business Transactions area, the Group is led by Wilson Hayman, Bill Shenton, and Marc Harris, who have a combined experience of almost 50 years in planning and executing a variety of transactions which encompasses the full spectrum of health care-related business transactions.   The Health Care Group represents and counsels clients in:

• Development and operation of integrated delivery systems

• Development and operation of managed care-related entities including PPO's, IPA's, PHO's, TPA's, and HMO's

• Development, acquisition and sale of facilities

• Joint ventures

• Mergers and acquisitions

• Negotiation of physician compensation with institutional providers, including rehabilitation and outpatient treatment and diagnostic centers

• Negotiation and contracting between physician groups and physician management organizations

• Organization of physician practices, including shareholder and partnership agreements and employment contracts

• Physician recruitment and employment issues

• Restructuring

 Recent illustrative experience includes:

• Representing hospital systems in leasing, managing and acquiring community hospitals

• Representing physicians and hospitals in formation and operation of IPA's, TPA's, and PHO's

• Representing various individual physicians and practice groups in matters involving admission, withdrawal, or termination of partners/shareholders

• Representing physician practice group in relocating to North Carolina municipality and all aspects of establishing new practice

• Representing owners of affiliated outpatient treatment centers in regards to multiple proposals for acquisition, affiliation and other investment options

• Representing community and regional hospitals in purchase and sale of physician practices and integration strategies generally

• Representing provider-owned HMO in sale of assets

• Representing nursing home providers in acquisition of other facilities

• Representing hospital systems in integrating services and facilities

Kim L. Bayless

C. Marcus Harris

Wilson Hayman

Charles F. Powers III

Steven A. Rowe

William R. Shenton

Lee A. Spinks

Provider Administration/Operations and Compliance

The Health Care Practice Group, supported by the firm's multidisciplinary corporate resources, including sections focusing in the areas of corporate, tax, public finance, employment, and employee benefits law, provides a full range of services relating to administration, operations and compliance issues faced by today's health care providers.  Wilson Hayman, Steve Shaber, and Bill Shenton, each have extensive experience in counseling individual and corporate clients regarding the full range of operational and compliance matters.  All have worked with the various state agencies that regulate health care during their prior service with the North Carolina Department of Justice, and have well-established relationships with these key agencies in North Carolina.  The Health Care Practice Group represents and counsels provider clients in the following operational areas:  

• Corporate and Non-Profit Governance

• Employment and Employee Benefit Issues

• EMTALA

• Fraud and Abuse

• Informed Consent and Advance Directives

• Insurance Regulations

• Managed Care Contracts between providers and payors

• Medical Records Protection

• Medical Waste Disposal and Environmental Requirements

• Medicare and Medicaid Certification and Compliance

• Pharmacy Regulation

• Reimbursement and Payment Matters

• Risk Management and Professional Liability

• Stark II and Anti-Self-Referral

• State Licensure and Certificate of Need Requirements

• Tax Exempt Financing

Recent experience includes:

• Counseling a physician group on compliance issues in billing

• Representing a hospital in a physician-credentialing hearing

• Representing Medicaid HMO in dispute with State regarding reimbursement for beneficiary who underwent heart-lung transplant

• Representing area mental health programs in challenge of State reimbursement formula

• Representing a physician in dissolution of a hospital-owned practice and sale of the practice to a different provider group

• Representing Institutional Review Board for medical device and research company

Kim Bayless

Wilson Hayman

Steven A. Rowe

Steven Mansfield Shaber

William R. Shenton

E-Health and HIPAA

The internet and transition from paper-based records and operations to computer and electronic operations have spawned the budding area of e-Health.  With the constant stream of new technologies, and new federal privacy, security and transaction regulations under the Health Insurance and Portability Assurance Act, health care providers face many new complex challenges in the delivery of health care to patients.  The Health Care Practice Group provides a full range of services in:

•   HIPAA Education

•   HIPAA Compliance

•   Telemedicine

•   Health Information and Technology

William R. Shenton

Provider Credentialing, Accreditation and Peer Review

The Health Care Practice Group represents individual providers, hospital medical staffs, and medical employers in all aspects of professional peer review, credentialing and licensing.  The Group is supported in this area by the firm's practice groups focusing in litigation, white collar crime, and employment matters. Our health care team furnishes legal services in all aspects of the following areas:

• Medical Staff Matters

• National Practitioner Data Bank Requirements and Proceedings

• Peer Review Matters (including hearings)

• State Licensure Proceedings

• EMTALA Actions

Recent experience includes:

• Representing physicians in hearings before the North Carolina Medical Board, North Carolina Psychology Board and the North Carolina Board of Pharmacy

• Representing physicians with respect to National Practitioner Data Bank reports

• Advising hospitals regarding making National Practitioner Data Bank reports

Louis B. Meyer III

Steven Mansfield Shaber

Lee A. Spinks

Thomas R. West

Legislative and Regulatory Issues  

In addition to counseling health care providers regarding specific issues that arise in the course of their practices and business operations, Poyner & Spruill provides health care clients experience and effective contacts and strategies in the areas of legislative lobbying and rulemaking.  Marvin Musselwhite, a former North Carolina legislator and seasoned lobbyist, represents clients in addressing health care issues with the General Assembly and various state agencies.  Tom West, a former administrative law judge, who has extensive contacts with numerous administrative agencies and more than 15 years of experience in administrative law, assists corporate and trade association clients in negotiating the administrative rulemaking process to promulgate or challenge administrative rules or policies that should have been enacted as administrative rules but were not.

 Recent experience includes:

• Representing a large mail order pharmaceutical company in challenging the result in a competitive bid to be selected as the provider for the State Employees' Health Plan and persuading the State to reconsider and reevaluate the competitive proposals

• Representing an association of assisted living providers in communicating the providers' concerns and position on recently proposed compliance regulations

Marvin D. Musselwhite

Thomas R. West

Health Care Attorneys:

Christopher P. Brewer