No Surprises Act Independent Dispute Resolution: Key Legal Developments; Ongoing Challenges; Stakeholder Impact

Mr. Hennessy represents traditional health care providers and life sciences companies alongside the emerging generation of digital health and AI-driven companies reshaping the industry, helping clients navigate the regulatory and transactional complexities of a rapidly evolving health care landscape. He counsels companies across the full spectrum of the industry, from physician practices, hospitals, health systems, and academic medical centers to pharmacies, clinical laboratories, medical foundations, DMEPOS suppliers, independent diagnostic testing facilities (IDTFs), federally qualified health centers (FQHCs), ambulatory surgical centers (ASCs), digital health providers and companies, telehealth providers, drug and device wholesalers, and behavioral health providers. He also represents life sciences companies and health industry-focused private equity firms, with particular experience in physician practice matters across radiology, gastroenterology, pathology, and other specialties. Mr. Hennessy's practice spans regulatory counseling, transactional work, and compliance, including the negotiation and drafting of provider agreements, acquisitions and divestitures, transactional due diligence, change of ownership matters, and the identification and resolution of regulatory concerns. He advises clients on federal and state fraud and abuse laws (Stark Law and Anti-Kickback Statute), Medicare and Medicaid participation and reimbursement, state corporate practice of medicine issues, and provider licensure and enrollment. James has particular depth in Stark Law matters, developed through years of complex physician practice representation across a wide range of specialties. Mr. Hennessy is also deeply versed in the Management Services Organization (MSO) model, having structured and implemented MSO arrangements for clients across the country, and brings market-informed guidance on structures and approaches drawn from broad experience with what leading organizations are doing in practice. He also counsels health care and life sciences companies including digital health and AI companies handling sensitive health data, on privacy and security compliance under the Health Insurance Portability and Accountability Act (HIPAA), the California Consumer Privacy Act of 2018 (CCPA), and California’s Confidentiality of Medical Information Act (CMIA).

Mr. Schutzer manages and leads complex civil litigation matters, with a focus on the healthcare industry. He regularly handles disputes involving healthcare reimbursement, coverage and regulatory issues. Mr. Schutzer has a special focus on emerging federal requirements affecting payors and providers, including the federal No Surprises Act. He also has significant government investigations experience, building on his tenure at the U.S. Department of Justice. While at DOJ he worked on investigating and litigating disability rights matters in the Civil Rights Division, including leading a team to a trial court victory in a lawsuit under Title II of the Americans with Disabilities Act. At the U.S. Attorney’s Office for the Southern District of California, Mr. Schutzer focused on healthcare fraud matters under the False Claims Act. He handled matters concerning millions of dollars of potential fraud against the Medicaid, Medicare, and TRICARE systems, often working in close partnership with the Department of Health & Human Services, the Department of Defense, the FBI, and other state and federal stakeholders. He stands ready to assist clients in resolving disputes with governmental entities and private parties alike.