Skilled Nursing Facilities & Long Term Care Providers

We guide you in selecting the ideal business entity, whether a Limited Liability Company (LLC) or a For-Profit Corporation, analyzing the distinct implications of each for liability protection, tax treatment, and administrative requirements. Our expertise extends to navigating the Florida Division of Corporations (Sunbiz) formation process, including the crucial steps of selecting a unique business name and appointing a registered agent. We ensure your structure provides clear and comprehensive disclosure of all controlling interests, satisfying the rigorous transparency requirements of the Agency for Health Care Administration (AHCA).

We structure your entity to navigate and comply with complex healthcare regulations like the Stark Law and the federal Anti-Kickback Statute. If physician investors or joint ventures are contemplated, we design the corporate framework to fit squarely within applicable safe harbors and exceptions, preventing prohibited financial relationships and mitigating significant compliance vulnerabilities from day one.

Beyond state filings, we recognize that internal governance documents are vital risk management instruments. We meticulously draft your foundational agreements, including Articles of Incorporation/Organization, Bylaws, Operating Agreements, and Partnership/Stockholder Agreements. These documents are tailored to the SNF landscape, defining governance, ownership rights, profit allocation, and dispute resolution, while embedding protocols for AHCA reporting and ongoing regulatory compliance.

Obtaining a license from AHCA is the cornerstone of operating an SNF in Florida. We expertly navigate the comprehensive application process, which is governed by multiple Florida Statutes and Administrative Codes. Our team assists in compiling all required documentation, including proof of financial ability to operate (PFA), Level 2 background screenings for all controlling interests, proof of insurance, and verification of qualified personnel. We manage responses to AHCA’s requests for information to prevent delays and ensure a successful outcome.

To receive Medicare or Medicaid payments, facilities must be certified by the Centers for Medicare & Medicaid Services (CMS). We guide you through the certification process, which involves an unannounced on-site survey assessing compliance with the Life Safety Code (LSC), a Standard Health Survey, and an Emergency Preparedness Survey, ensuring CMS grants the final determination of eligibility.

We ensure compliance with all municipal requirements, securing local business tax receipts, fire safety permits, and necessary health department approvals for services like food service. Our team also verifies compliance with local zoning and land use regulations, which is critical for site selection and development.

We advise on the strategic benefits of pursuing accreditation from respected bodies like The Joint Commission or CARF. While not always mandatory, we understand that accreditation can enhance quality of care, improve marketability, and serve as a proactive strategy to bolster your compliance posture and mitigate operational risks.

We navigate the complexities of government payor enrollment. This includes obtaining National Provider Identifiers (NPIs), utilizing the Provider Enrollment, Chain and Ownership System (PECOS), and submitting the detailed CMS-855A application for your facility. We ensure you meet all new disclosure requirements and manage the periodic revalidation to avoid any disruption in payment. For Florida Medicaid, we manage the entire process through AHCA’s online portal, ensuring submission of all required data, from background screenings to proof of financial viability.

Beyond government programs, we manage the credentialing process with commercial insurance companies, Medicare Advantage plans, and Medicaid Managed Care Organizations. Our attorneys skillfully negotiate these crucial payor contracts, focusing on securing favorable terms that protect your facility’s financial interests. We scrutinize every detail, from reimbursement rates and medical necessity criteria to appeal processes and timely filing deadlines.

We navigate the complexities of Florida real estate law to secure your ideal location. Whether you are purchasing or leasing, our team conducts thorough due diligence, including zoning verification, and ensures the property meets AHCA’s detailed physical plant and Life Safety Code standards. All agreements are structured to be compliant with the Anti-Kickback Statute and Stark Law, particularly when referral relationships exist.

Your SNF requires a vast range of equipment, and we meticulously negotiate these purchase and lease agreements. We focus on securing strong warranties, clear maintenance responsibilities, and favorable liability terms, while ensuring every agreement complies with healthcare fraud and abuse laws.

We draft the initial suite of policies and procedures mandated by AHCA before you even open your doors. Our attorneys create clear, compliant written policies covering admission and discharge, resident rights, infection control, and disaster preparedness, among others, ensuring you begin operations on a solid compliance footing.

We put in place compliant employment agreements for your key personnel, such as the Administrator and Director of Nursing. We also develop a foundational employee handbook that outlines critical policies on Equal Employment Opportunity (EEO), HIPAA, at-will employment, and a code of ethics, setting the standard for your workforce from day one.

Florida law dictates that nursing homes must maintain written policies covering an extensive range of operational and care-related areas. We develop and continuously review policies covering everything from resident activities and advance directives to disaster preparedness, infection control, medical records management, and nursing services, ensuring you meet or exceed every state mandate.

We draft and help you rigorously implement policies that uphold Florida’s extensive Resident Bill of Rights, ensuring dignified treatment, privacy, and freedom from abuse. Our team develops clear, compliant policies for admission, transfer, and discharge that align with both state and federal regulations, including strict notice requirements. We also create robust policies to guide the resident assessment (RAI) and interdisciplinary, person-centered care planning processes.

We guide you in conducting the comprehensive, facility-wide assessment mandated by federal regulations to determine necessary resources and staffing. Building on this, we help you develop, implement, and maintain an effective, data-driven Quality Assurance and Performance Improvement (QAPI) program, aligning your operations with the five core elements of QAPI to continuously identify and correct quality deficiencies.

Our attorneys guide you in conducting regular IT risk assessments to ensure the confidentiality, integrity, and availability of electronic Protected Health Information (ePHI). We develop robust policies for data backup, disaster recovery, and emergency mode operation, and we ensure that all your third-party IT vendors have compliant Business Associate Agreements (BAAs) in place, protecting you under both HIPAA and the Florida Information Protection Act (FIPA).

We ensure every employee is correctly classified as exempt or non-exempt under the Fair Labor Standards Act (FLSA) and Florida’s minimum wage laws to prevent costly wage and hour disputes. We draft ironclad employment contracts for key personnel and create a comprehensive, regularly updated employee handbook. This handbook is your critical risk management tool, addressing everything from EEO and anti-harassment policies to mandatory abuse reporting, HIPAA, and whistleblower protections.

We view the employee handbook as more than a guide; it is a critical defense document. In the highly litigious SNF environment, a meticulously drafted and consistently enforced handbook educates staff, establishes clear expectations for conduct, and provides a powerful defense against employment litigation and regulatory enforcement actions. We ensure this dynamic document is always current, protecting your facility from substantial legal and financial liability.

We establish clear protocols for conducting prompt, impartial, and thorough workplace investigations into any allegation of misconduct. Our team expertly navigates employment disputes, including complaints filed with the EEOC or the Florida Commission on Human Relations. We provide strategic guidance on all termination decisions, ensuring thorough documentation and minimizing the risk of wrongful termination claims in Florida’s at-will employment environment.

We believe regular, comprehensive training is a regulatory necessity, not just a best practice. Our firm develops and delivers targeted training programs for your staff on critical topics including Resident Rights, HIPAA, abuse prevention, emergency preparedness, and workplace harassment, empowering your team with the knowledge to maintain compliance.

The terms of your contracts with commercial insurers, Medicare, and Medicaid dictate your financial stability. Our attorneys are expert negotiators, securing favorable terms, fair reimbursement rates, and clear compliance obligations that support your operational needs and drive profitability.

Participation in government payor programs comes with an intricate set of rules. We provide the legal guidance necessary to navigate evolving reimbursement methodologies, complex billing and cost-reporting standards, and value-based purchasing initiatives, helping you avoid claim denials and overpayment liabilities.

The healthcare industry is under intense scrutiny from a host of auditors (RACs, ZPICs, UPICs). We develop proactive audit preparedness programs and mount an aggressive defense in the event of an audit. Our team crafts compelling responses to audit findings and skillfully manages appeals, advocating for your rights in any payment dispute with government or commercial payors.

Our firm manages the entire mergers and acquisitions (M&A) process. We draft and negotiate letters of intent (LOIs), conduct exhaustive due diligence into financial and regulatory histories, and negotiate every facet of the purchase agreement to protect your interests, ensuring a seamless transaction from start to finish.

SNF transactions involve unique regulatory hurdles. We expertly manage the Change of Ownership (CHOW) requirements with Medicare and Medicaid, ensure the proper transfer of AHCA licenses, and maintain compliance with fraud and abuse laws throughout the process to prevent delays or post-closing liabilities.

Real estate is a cornerstone of your facility. Our legal services cover all aspects of buying, selling, and leasing commercial real estate for SNF use, including zoning, land use, financing, and addressing the unique physical requirements of a healthcare facility.

For buyers, our due diligence is a primary risk mitigation tool, protecting you from inheriting devastating liabilities from the seller. For sellers, we help you maintain “clean” operations and meticulous records, transforming your consistent compliance into a tangible asset that enhances your facility’s valuation and attractiveness to potential buyers.

We provide a deep understanding of the key federal fraud and abuse laws, including the Anti-Kickback Statute (AKS), the Stark Law, and the False Claims Act (FCA). Our counsel ensures all your operations, from physician contracts to referral source relationships, are structured to fit within safe harbors and statutory exceptions, protecting you from severe penalties.

We are experts in HIPAA’s stringent requirements. Our firm develops comprehensive privacy and security policies, guides you through security risk assessments, establishes breach response protocols, and ensures all vendor contracts include ironclad Business Associate Agreements.

Beyond written policies, the most effective risk mitigation strategy is a strong culture of compliance that permeates your entire organization. Our legal guidance helps you build and nurture this ethical and compliant culture, empowering employees to report concerns and correcting issues internally before they escalate into government investigations or whistleblower lawsuits.

Marketing practices that are standard in other industries can easily violate the AKS in healthcare. We provide meticulous legal review of all marketing initiatives, referral relationships, and compensation structures to ensure they are compliant and do not constitute illegal inducements, protecting you from severe civil and criminal penalties.

We structure your relationships with marketing personnel and third-party agencies to be fully compliant with anti-kickback laws. This includes drafting and reviewing employment and agency contracts to include necessary safeguards and compliance attestations.

We ensure your marketing activities scrupulously adhere to HIPAA, including obtaining proper written consent for patient testimonials or photos. Our team provides guidance on website content, social media, and online review management to ensure accuracy, avoid misleading claims, and respond to feedback without violating patient privacy.

The initial structuring of your SNF is a critical decision with far-reaching implications for liability, taxation, and governance. We help you select the optimal corporate structure, such as an LLC or Corporation, and craft essential governing documents like operating agreements or bylaws.

Operating legally requires navigating a complex maze of approvals at the state, federal, and local levels. The cornerstone is obtaining a license from Florida’s Agency for Health Care Administration (AHCA). Beyond that, facilities must secure CMS certification for Medicare/Medicaid participation and various local permits, such as business tax receipts and fire safety permits.

Once licensed, SNFs and their staff must enroll with various payors to receive reimbursement. This includes enrolling as a Medicare provider through the PECOS system and as a Florida Medicaid provider through AHCA’s online portal.

Comprehensive legal counsel during the start-up phase extends to critical operational agreements. This includes real estate purchases or leases, equipment purchase agreements, and foundational policies and procedures as mandated by AHCA.

This federal law prohibits offering or receiving remuneration to induce referrals for services covered by federal healthcare programs. It impacts referral relationships, vendor contracts, and marketing practices.

This law generally prohibits physicians from referring Medicare or Medicaid patients to entities where they have a financial relationship, unless a specific exception applies. It is critical for physician contracts and ownership structures.

The FCA imposes liability on persons and companies who defraud governmental programs. It directly relates to billing practices, coding, and the documentation supporting medical necessity.

The Health Insurance Portability and Accountability Act (HIPAA) mandates stringent protections for patient privacy and the security of Protected Health Information (PHI).

In Florida, AHCA sets specific standards for nearly every aspect of facility operations, including licensure, staffing levels, quality of care, resident rights, and emergency preparedness.

We ensure all employees are correctly classified under the Fair Labor Standards Act (FLSA) to ensure proper payment and avoid significant liabilities.

A comprehensive and regularly updated employee handbook is a cornerstone of effective HR management and risk mitigation. We view the handbook as a critical risk management document that can serve as vital evidence in defending the facility against litigation or regulatory actions.

We establish clear protocols for conducting prompt, impartial, and thorough workplace investigations into any allegations of misconduct. We also provide careful review of all termination decisions to minimize the risk of wrongful termination claims.

For SNFs, due diligence extends far beyond financial statements. It requires a deep dive into the facility’s compliance history, including past survey results from AHCA, payor audits, and any history of fraud and abuse allegations. An acquiring SNF can, under certain circumstances, inherit pre-existing liabilities from the seller.

SNF transactions are subject to specific healthcare regulatory considerations, including navigating Change of Ownership (CHOW) requirements with Medicare and Medicaid and ensuring the proper transfer of state licenses from AHCA.

For owners contemplating a sale, a consistent record of impeccable regulatory compliance and well-organized legal and financial records significantly enhances the facility’s attractiveness and valuation. A facility that can demonstrate robust compliance programs and transparent reporting presents a far less risky and therefore more appealing acquisition target.

We offer a comprehensive suite of services that covers nearly every aspect of an SNF’s business lifecycle, positioning our firm as a proactive strategic business partner. We directly address core business challenges to help your SNF thrive, not just survive.

The value of our counsel extends beyond reacting to problems. We are instrumental in proactively mitigating risks, safeguarding your assets and reputation, and supporting sustainable growth.

By entrusting these complex legal and regulatory responsibilities to our specialists, your leadership can gain confidence and free up essential capacity. This allows you to dedicate your full attention to what matters most: your residents.