LITIGATION AND APPELLATE PRACTICE
Ruffo, Tabora, Mainello and McKay PC´s litigation practice includes insurance defense, self-insured defense, commercial and payment dispute litigation, along with affirmative litigation to protect client rights.
INSURANCE DEFENSE
RTM&M´s attorneys have extensive experience in insurance defense litigation, primarily in the area of municipal defense where RTM&M represents municipalities and school districts. Insurance defense involves many diverse and complex legal issues, including personal injury, civil rights, discrimination and sexual harassment claims. RTM&M´s experience involves the defense of complex insurance cases in both federal and state courts.
Within the field of general casualty, RTM&M represents landlords in a host of premises liability claims including cases alleging lead poisoning to other premises liability matters, such as crime victims alleging security violations, assault and rape as proximately related to owner negligence.
SELF-INSURED
Many organizations are self-insured in some areas of business operations such as claims involving contract matters, discrimination and/or property management. RTM&M provides comprehensive legal representation and litigation defense to clients who require defense litigation
COMMERCIAL LITIGATION
RTM&M represents public and private entities, not-for-profit and for-profit corporations, who become involved in a myriad of business activities. Commercial litigation includes cases involving contract disputes, payment issues, and issues involving real and personal property, among other matters. Our clients include health care institutions, assisted living facilities, long term health care organizations, as well as schools, municipalities, town and village boards and their trustees. Our representation also involves a wide array of affirmative claims seeking to enforce the rights of our clients.
PAYMENT DISPUTE LITIGATION
RTM&M works cooperatively with business clients to assess and/or prevent payment disputes. The field of health care services, in particular, is heavily regulated and complex. With regard to health care clients, counseling includes advice and preparation of forms such as admission agreements, private pay agreements and net available monthly income (NAMI) or surplus agreements with regard to long term care providers. RTM&M will pursue all available avenues to assist our clients in this area including guardianships, claims under the Fraudulent Conveyance Act and prosecuting health benefit appeals or TPL recoveries.
GUARDIANSHIP AND ESTATE MATTERS
Guardianship proceedings are often required where an individual has not designated a health care proxy or provided for a power of attorney. RTM&M has developed extensive experience in representing institutional and non-institutional clients in petitioning for guardianship in cases involving a lack of responsible representatives. RTM&M also represents clients in estate matters where claims must be filed for recovery of amounts owed by deceased individuals or where health care providers are designated as beneficiaries under a will or trust.
HEALTH CARE PRACTICE
Ruffo, Tabora, Mainello and McKay PC has developed a comprehensive health care practice bringing together decades of experience in the highly regulated areas of health care operations and third-party reimbursement. The following sub-topics describe some of the specific fields in this area of practice.
CORPORATE & FINANCE
As general counsel to many health care organizations, RTM&M’s services include general corporate legal services in connection with the formation, governance and operation of health care organizations, along with representation and advice to Boards of Directors, Members and their governing authorities.
MERGERS, REORGANIZATIONS, FINANCING, SALES AND ACQUISITIONS
Health care organizations are increasingly involved in mergers, acquisitions and reorganizations. RTM&M provides a full range of regulatory and corporate guidance and transactional services in this regard. In addition, RTM&M has represented numerous health care organizations in complex financing transactions, including tax exempt and taxable borrowings as well as credit enhancement transactions involving letters of credit and FHA mortgage insurance.
EXEMPT ORGANIZATIONS
RTM&M represents numerous tax exempt, charitable health care providers and foundations, providing guidance in all areas of State and Federal tax exempt compliance. Such services include obtaining approvals and preparing documentation required by the Charities Bureau of the New York State Attorney General’s Office, obtaining tax exempt determination letters from the Exempt Organization’s unit of the Internal Revenue Service, and counseling involving compliance with all applicable IRS requirements, including questions relating to Form 990 and Excess Benefit Transactions.
REGULATIONS AFFECTING OPERATIONS - SURVEY AND CERTIFICATION
Institutional and non-institutional providers are subject to ever increasing oversight of their operations. New statutory and regulatory mandates are added on a regular basis. Long term care providers are subject to mandated surveys and investigations of resident abuse, mistreatment or neglect which can lead to the loss of Medicare and Medicaid reimbursement along with potential closure and civil monetary penalties. RTM&M provides comprehensive counseling in these areas, including assistance in HIPAA compliance, review of policies and procedures regarding new mandates, assistance in drafting plans of correction, submitting matters for informal dispute resolution and representation in administrative hearings and litigation involving survey enforcement.
LICENSURE AND ESTABLISHMENT
New York requires that health care be furnished by duly licensed, certified or approved organizations. The “Certificate of Need” or “CON” process generally refers to those laws which require that entities submit establishment or licensure applications in order to engage in certain health care activities or expand into new areas of service. RTM&M provides legal assistance in all aspects of CON and licensure counseling, including assistance in the drafting and submission of all legal documentation regarding such applications as well as the provision of advice and recommendations as to operational requirements for each type of provider service.
HEALTH CARE REIMBURSEMENT - TPL
Medicare, Medicaid, HMO, Managed Care and Private pay represent the predominant source of funding of health care operations. RTM&M provides a full range of counseling, contract development and litigation services in these areas, with a special emphasis on third-party reimbursement litigation with respect to audits, rate appeals and retroactive adjustments/recoveries. Third Party Liability (TPL) refers to the general concept of a “third party” who may be responsible for the payment of health care services (i.e. someone other than the provider and patient). RTM&M has developed years of experience in identifying TPL so that the proper source of payment ultimately pays for health care.
INDEPENDENT HOUSING, ADULT CARE RESIDENCES AND ASSISTIVE LIVING
Health care organizations have been ever expanding their scope of services, to include independent housing, adult care facilities and assistive living. RTM&M provides counseling and support services in connection with the development, financing, construction and operation within these fields.
SPECIALIZED CONTRACT DEVELOPMENT
Unlike many other industries, health care operations demand special provisions and requirements for most vendor contracts, affiliations or outside relationships. RTM&M´s attorneys have extensive experience in all such contracting relationships. These may include ancillary services such as laboratory, radiology or dialysis to affiliation agreements, construction contracting and third party payor relationships with Medicare Advantage Plans or private indemnity insurers.
FRAUD ABUSE PREVENTION AND COMPLIANCE SERVICES
Fraud abuse prevention and compliance services include counseling and assistance in the development of a compliance plan for organizations along with the arrangement of training, in-service and on-going reviews of compliance issues. RTM&M also works cooperatively with accounting firms, in-house counsel and compliance consultants, when necessary, in the assessment and review of complaints or reviews required to assure health care compliance or prevent fraud and abuse in health care operations and billings.
EMPLOYMENT LAW
As general or special counsel to health care organizations, RTM&M provides counseling regarding general employment related issues. Employment related matters may include review and counseling regarding individual employee complaints, terminations, and matters pertaining to the work place such as sexual harassment, discrimination, wage & hour requirements and concerns arising under the auspices of the Occupational Health and Safety Administration (“OSHA”). RTM&M does not provide representation with regard to collective bargaining agreements as a general matter.
