With more than 20 years of experience in healthcare law, Robert Belfort advises healthcare organizations on regulatory compliance and transactional matters. His clients include hospitals, medical groups, health insurers, managed care organizations, accountable care organizations (ACOs), mental health providers, pharmacy chains, IT vendors and healthcare industry trade associations.
For health insurers and other MCOs, Bob helps ensure compliance with federal and state rules and regulations. These include Affordable Care Act standards, Medicare Part C and Part D rules, HIPAA portability and nondiscrimination mandates, state insurance licensing and market conduct laws, and Medicaid managed care requirements.
Bob also counsels insurers and providers that are establishing ACOs and other value-based contracting arrangements. In addition, he drafts and negotiates managed care and accountable care contracts, such as provider participation agreements, specialty carve-out and pharmacy benefit manager arrangements.
Organizations with privacy concerns turn to Bob for advice on managing health information within the parameters established by HIPAA and state confidentiality laws. He drafts privacy policies, conducts internal gap analyses, partners with clients to develop other privacy safeguards, and helps clients respond to complaints and privacy breaches. Bob also works with regional health information organizations and other entities to develop policies and practices about patient consent and other data sharing.
To proactively avoid fraud and abuse, Bob advises clients on structuring transactions and conducting business in compliance with the Anti-Kickback Statute, the Stark law, participation and billing requirements for Medicare and Medicaid, professional licensing rules, and the corporate practice of medicine and fee-splitting restrictions. He also performs risk assessments, develops compliance programs, conducts internal investigations, and represents clients in government investigations and audits.