Healthcare

Navigating the health care industry’s complex federal and state regulatory framework is a key part of doing business for any provider of medical services. Yamamoto Caliboso Hetherington is home to the leading health care law practice in Hawaii. 

Our health care clients include hospitals and health systems, long-term care facilities, assisted living facilities, ambulatory surgery centers, diagnostic imaging centers, clinical laboratories, durable medical equipment manufacturers, providers, and distributors, pharmacies and pharmacy benefit managers, mail-order pharmacies, pharmaceutical manufacturers, management companies (MSOs), provider associations, health and dental insurers and managed care organizations, home health providers, community health centers, urgent care centers, dental groups, physician groups and primary care and specialty physicians.  We have decades of experience assisting these clients with a variety of transactions, including mergers, acquisitions, joint ventures, and capital formation. 

We frequently counsel health care clients on the resolution of complex legal issues related to state licensing, certificate of need, CMS certification, facility surveys, Medicare and Medicaid reimbursement, structuring arrangements and transactions to comply with federal fraud and abuse laws (Anti-Kickback Statute, Stark Law, and the False Claims Act), fraud and abuse self-reporting and investigations, defending against False Claims Act and qui tam actions,  HIPAA compliance and breach reporting, physician contracting and compensation arrangements, hospital medical staff credentialing and peer review, forming outpatient health care facilities (including physician-hospital joint ventures and physician-owned facilities), and developing general compliance plans and risk management strategies.  Our firm also represents providers in investigations and proceedings before many government and regulatory agencies, such as the Department of Health and Human Services Office of Inspector General, U.S. Department of Justice, Medicaid Fraud Control Unit, Office of Health Care Assurance, State Health Planning & Development Agency, Regulated Industries Complaints Office, Hawaii Medical Board, Hawaii Board of Pharmacy and other state licensing boards.  

Yamamoto Caliboso Hetherington also works with a number of Taft-Hartley benefit plans as fund counsel, helping such clients operate within the many laws and regulations governing multiemployer plans, including the Internal Revenue Code and ERISA, and their numerous complex updates (e.g., COBRA, HIPAA, ACA), in addition to the relevant provisions of the Social Security Act (including the Medicare provisions), and the Taft-Hartley Act itself.  We provide counsel to union-affiliated pension (defined benefit and defined contribution), health and welfare, training, vacation and holiday, and industry stabilization plans on the many issues that present during the course of plan administration and management, such as pension funding issues, plan design, service provider contracts, investment advisory agreements, tax qualification, plan mergers and dissolution. Our services include plan drafting and amendment, litigation, collections, and ongoing advice for daily operations, fiduciary responsibility, benefit claims, reporting and disclosure, prohibited transactions, and withdrawal liability.  We also regularly participate in regulatory matters involving the Department of Labor, Internal Revenue Service, and PBGC, in addition to representing our Taft-Hartley clients in arbitration or litigation.