Long Term Care

Fenton Nelson is a leader in the counseling of long-term care facilities, including skilled nursing facilities (SNF’s), assisted living/residential care facilities for elderly (RCFE’s), adult residential facilities (ARF’s), adult day health care centers (ADHC’s), rehabilitation facilities, and inpatient behavioral health facilities.  We have an extensive number of clients who operate home health agencies (HHA’s) and hospices. We specialize in assisting providers in developing and implementing effective regulatory compliance programs, and representing them when regulatory issues emerge.

While Fenton Nelson represents clients nationwide on issues of Medicare compliance, we bring a unique level of expertise of California-specific laws and regulations.  We have served as compliance officers for over 50 facilities. We have defended long-term care clients' interests before courts and federal and state enforcement agencies, including the California Department of Public Health, California Department of Justice, and Centers for Medicare and Medicaid Services.

Long term care facilities are regulated at both the federal (Medicare) and state (facility licensing and Medicaid) level.   As long-term care continues to be a growth sector of the healthcare industry due the aging population and increasing number of patients with chronic health conditions, it is inevitable that long-term care facilities will be subjects of ever greater scrutiny from federal and state regulators.  A review of the 2010 health care reform legislation, for example, reflects this trend, with many specific provisions focused on skilled nursing facilities and other long-term care facilities.

Long term care providers are often not aware they are not out of compliance until it is too late.  With so much regulatory oversight, providers depend on Fenton Nelson’s base of knowledge and experience to ensure sure they are compliant in advance and, when necessary, to address audits and investigations.   In addition to developing and implementing compliance plans (a requirement in the new healthcare legislation), as well as conducting internal audits to ensure proactive compliance.   

Representative, recent experience in this area includes:

-Developed multiple, comprehensive compliance plans for a chain of skilled nursing facilities (2010);

-Revised model contracts for skilled nursing facilities to ensure Anti-Kickback Statute compliance (2010);

-Numerous successful Medicare appeals of overpayment determinations;

-Defended whistleblower investigation against adult residential facility investigation successfully resolved without any charges against facility (2009);

-Represented seller of single skilled nursing facility in stock purchase transaction (2009);

-Represented seller of multiple skilled nursing facilities in distressed asset sale, preventing closure of facility (2008);

-Appealed temporary suspension of multiple adult day health care providers by the Medi-Cal Program; successfully negotiated resolutions (2009);

-Developed HIPAA compliance plan for behavioral health facility (2009); and

-Served as Independent Review Organization (IRO) for provider subject to Corporate Integrity Agreement (CIA).