Children’s Hospitals

Hall Render attorneys understand the specific issues facing today's children's hospitals and stand ready to assist these specialty hospitals with legal matters. Reimbursement issues are key; children's hospitals are heavily affected by Medicaid policy and reimbursement changes as they treat a significant number of Medicaid patients. Hall Render attorneys can assist hospitals with reimbursement matters related to Medicaid and also the Children's Health Insurance Program ("CHIP") providing health insurance for children of families who earn too much money to qualify for Medicaid but cannot afford to buy private health insurance.

Children's hospitals may be in a position to enter into relationships with Medicaid managed care companies ("MCCs") in which they may direct patient care and, in some cases, perform administrative functions.  Our attorneys can advise children's hospitals on the legal issues related to their relationships with MCCs.

We are knowledgeable on the many provisions of the Affordable Care Act that directly affect children's hospitals.  For example, we can help children's hospitals establish accountable care organizations or other population health management structures.

Like all other hospitals, children's hospitals must have vigorous compliance programs in place to reinforce ethical and legal business practices and to detect and prevent fraud and abuse.  While Medicare accounts for a minimum of children's hospitals' revenues, Medicaid is a major payor. Fraud and abuse involving the Medicaid program can result in civil or criminal liability under the Anti-Kickback Statute, False Claims Act and Stark Law.  We can prepare all manner of compliance-oriented policies and procedures, oversee compliance education and training, perform compliance auditing and help hospitals to resolve identified compliance lapses.

Attorneys who work with children's hospitals must be prepared to deal with special medical-legal issues that may arise with the pediatric population. Child abuse or neglect cases and cases where the religious beliefs of parents or guardians may be deemed by the hospital's medical staff to be adverse to the best interests of the pediatric patient are difficult issues we are prepared to tackle.

Finally, many children’s hospitals are associated with academic medical centers ("AMCs"); as such, AMC-affiliated children's hospitals (and even many children's hospitals that are not AMC-affiliated) champion the three prong mission of  patient care, graduate medical education and research.  Research is important.  Few of the drugs and devices approved by the FDA are designed specifically for children. Given the  development of organs and changes in metabolism children experience as they grow, there is a great need for clinical research studying  illness in children. Children’s hospitals are instrumental in conducting this research, which encompasses pediatric illnesses of all kinds, including a wide variety of pediatric cancers, systemic infection in premature infants, hemophilia, obesity and sickle cell anemia, among many others. We can assist with all legal aspects of pediatric population-focused research.