Accountable Care Organizations & Physician Hospital Alignment Strategies

Overview

As dedicated legal partners to healthcare providers and ACOs, our firm leverages strong relationships and open communication with regulators at the Center for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation. This enables us to effectively guide our ACO in the healthcare industry with regulatory ambiguities and solve problems related to unintended consequences of the law. Additionally, our lawyers advise physician practices on a wide variety of matters related to physician hospital organizations, practice formation, and alignment strategies.

We routinely counsel not-for-profit health systems in various matters including the formation of joint ventures, development of provider compensation structures, financing, and the management of related compliance. We have the right team, experience, and skillset to help your organization achieve successful outcomes.

Representative experience

• ACO: Represented in connection with fraud and abuse waivers, strategic planning, and governmental audits
• Provider of healthcare service: Advise on various matters involving ACOs as well as a clinical affiliation with a specialty and urgent care clinic
• Nonprofit research and academic medical center: Advised on a variety of ACO and CIN focused matters
• Federally qualified health center: Represented in various matters including the client’s interest in the sale of a health plan and their membership interest in a new innovator ACO
• Not-for-profit health system: Served as corporate and regulatory counsel in its acquisition of a primary care ACO with more than 125 providers across 20 medical offices
• Start-up organization formed by 20 not-for-profit human services agencies: Represented the organization in connection with various matters including the negotiation of an infrastructure agreement for a new innovator ACO program in NY and a physician participation agreement structure
• Children’s hospital: Served as outside counsel for all regulatory and transactional matters with respect to physician alignment issues, and advice in connection with affiliations with other providers
• Nonprofit hospital: Represented in connection with several physician practice acquisitions, the formation of an outpatient clinic network, and their overall physician alignment strategy
• Regional hospital: Represented the hospital in connection with their overall physician-hospital alignment strategy

Recognition

• Nixon Peabody has been named a Tier 1 National firm for Health Care Law in the 2024 edition of Best Law Firms® and in consecutive years prior; named “Law Firm of the Year” in Healthcare Law by Best Law Firms in 2016
• Named as a leading firm in Healthcare by Chambers USA in 2021; 31 healthcare lawyers ranked
• Recognized as a top law firm in Healthcare by the American Bar Association’s Health Law Section
• Ranked nationally as one of the largest healthcare firms by Modern Healthcare