Ambulatory Surgery Centers & Free-Standing Emergency Departments

Legal & Regulatory Counsel for Ambulatory Surgery Centers & Freestanding Emergency Departments

Ambulatory surgery centers (ASCs) and freestanding emergency departments (FSEDs) have become attractive options for providing specific procedures and care outside of hospital-based settings.

While popular among patients and practitioners, ASCs and FSEDs also present an array of structural, billing, and reimbursement challenges, and are subject to intense scrutiny from government regulators. For those looking to invest in this space while staying out of regulators’ crosshairs, there is no substitute for counseling an attorney experienced with ambulatory surgical centers and freestanding emergency departments.

Hendershot Cowart P.C. serves as a strategic legal partner for physician owners, hospital executives, and other health care entities in ambulatory surgery center and freestanding emergency department matters ranging from formation and ownership models to ongoing compliance with state and federal regulations, and health care fraud defense.

Our lawyers understand the unique challenges related to the acquisition, structure, and operation of ASCs and FSEDs and have the experience to help clients mitigate risks with comprehensive and insight-driven counsel. Call or contact us to speak with a lawyer.

Legal & Regulatory Counsel for the Life of Your ASC & FSED Investment

Our health and medical law team at Hendershot Cowart P.C. leverages decades of experience to represent clients in a range of transactional and regulatory matters.

We take a team approach to supporting FSED / ASC operations and their complex networks of care on both a proactive and responsive basis. Our services include:

• ASC / FSED investments, mergers and acquisitions, joint ventures, etc.
• Formation, corporate structure, and governing documents
• State and federal securities compliance and financing
• Physician employment agreements, medical contracts, and compensation
• Licensure and certification
• Billing agreements and reimbursement / insurance claim denials
• Regulatory compliance (Anti-Kickback Statute, Stark, and other federal / state health care laws)
• Ownership and investment regulations, safe harbors, and compliance
• Private insurance audits, overpayment, and recoupment
• Federal health care fraud investigations
• Owner and partnership disputes
• Trade name disputes / infringement

Hendershot Cowart P.C. represents physicians, group practices, hospitals, and other health care entities in developing, acquiring, and operating general and single- or multi-specialty ambulatory care and freestanding emergency departments, including general surgery, oncology, ophthalmology, women’s health, and more. Our Houston-based attorneys serve health care clients across Texas and the U.S.

Ambulatory Surgery Center Regulations & Compliance

Developing and operating a successful ambulatory surgery center requires a comprehensive approach that reconciles business objectives with matters of licensure, real estate, finances, and corporate structure – all while maintaining compliance with complex and evolving state and federal regulations.

Ambulatory surgery center operators face a litany of concerns related to compliant transactions, structure, and billing under state and federal law. These include:

• Heightened regulatory scrutiny: Government regulators have steadily increased their focus on ambulatory surgery to investigate and prosecute health care fraud involving the Stark Law, Anti-Kickback Statute, and billing violations. ASCs are also likely to be targeted in audits that can lead to referrals to government agencies for further investigation.
• Compliance policies: ASCs should establish sound compliance policies that stand up to government scrutiny. A comprehensive compliance plan that is routinely audited and refined can be a powerful and effective first line of defense in any audit, investigation, or enforcement action.
• Claim denials: ASC owners must be diligent in their billing practices and documentation to mitigate risks of claim denials and the threat of additional scrutiny from regulators who are likely to further investigate entities with high denial rates.
• ASCs and the Anti-Kickback Statute (AKS): Physician ownership of an ASC must satisfy all requirements of the appropriate safe harbor to avoid running afoul of the AKS. This includes ensuring that owners are surgeons who perform procedures in the ASC, or ensuring physicians are not able to make or influence referrals to the ASC.

Freestanding Emergency Center Regulations & Compliance

Freestanding emergency centers or departments are operated independently of acute care hospitals. They may be owned by medical centers or hospital systems (hospital outpatient departments) or by independent groups or physicians.

FSEDs can face many challenges in battling for reimbursement from Centers for Medicare & Medicaud Services (CMS) and third-party payers, which is why structure, compliance, and billing practices must be addressed at the formation or acquisition of any freestanding emergency care facility. Such practices can also aid in helping owners defend against audits or investigations.

In response to the COVID-19 pandemic, CMS has created flexibilities to allow licensed independent free-standing emergency departments to participate in Medicare and Medicaid. In addition to providing counsel for matters of formation, licensure, compliance, and health care fraud defense, Hendershot Cowart P.C. also counsels health care clients in exploring their options to serve Medicare and Medicaid populations under temporary waivers.

Hendershot Cowart P.C.: Over 150 Years’ of Collective Experience

Backed by over a century of collective experience, our Houston-based attorneys proudly serve health care professionals and medical business owners throughout Texas and beyond.

If you have questions about establishing an ambulatory surgical center or freestanding emergency center, or require representation in matters of contract disputes or health care fraud investigations, call or contact us online to speak with a lawyer.