The long-term care industry operates under some of the most demanding regulatory scrutiny in healthcare. Home care agencies, assisted living residences, adult day health programs, and skilled nursing operators face overlapping oversight from state health departments, CMS, and managed care organizations — all while managing the day-to-day realities of staffing, resident care, and financial sustainability. A single survey deficiency, audit finding, or contract dispute can threaten an operator's license and livelihood.

MDRXLaw's healthcare attorneys bring practical, in-the-trenches experience to the long-term care sector, helping licensed home care services agencies (LHCSAs), certified home health agencies (CHHAs), managed long-term care plans (MLTCs), assisted living residences, adult day care programs, and long-term care facilities navigate the legal and regulatory issues unique to their business.

How We Help

• Licensure & Certification

  Applications, renewals, change of ownership (CHOW) filings, and certificate of need (CON) proceedings before state health departments.

• Medicaid & Medicare Compliance

  Enrollment, billing compliance, cost reports, and defense against overpayment allegations.

• MLTC & Managed Care Contracting

  Provider network agreements, rate disputes, and audit appeals with managed long-term care plans and other payers.

• Survey & Enforcement Defense

  Responding to Department of Health surveys, statements of deficiency, plans of correction, and enforcement actions, including fines and license restrictions.

• Audits & Appeals

  Defending Medicaid, Medicare, and MCO audits and pursuing administrative appeals to reduce or eliminate alleged overpayments.

• Regulatory Investigations

  Representing providers in state and federal investigations, including OMIG, OIG, and Medicaid Fraud Control Unit inquiries.

• Fraud & Abuse Compliance

  Anti-Kickback Statute, Stark Law, and False Claims Act risk assessments and compliance program development.

• Resident Rights & Admission Agreements

  Drafting and reviewing admission agreements, resident contracts, and policies to minimize liability while meeting regulatory requirements.

• Employment & Staffing Issues

  Guidance on staffing ratios, wage and hour compliance, and workforce regulatory requirements specific to the caregiving industry.

• Business & Corporate Transactions

  Mergers, acquisitions, joint ventures, and corporate structuring for home care and long-term care operators.

• Litigation & Dispute Resolution

  Representing agencies and facilities in contract disputes, regulatory appeals, and litigation, including through MDRXResolve, our dedicated mediation platform for healthcare providers.

Whether the challenge is a Medicaid audit, a contested survey finding, a payer contract dispute, or a business transaction, MDRXLaw delivers the industry-specific knowledge and aggressive advocacy that home care, assisted living, and long-term care providers need to operate with confidence.