Nesko practices in the firm’s healthcare department and focuses on a variety of regulatory, compliance, and corporate matters within the healthcare and life sciences industries.
Nesko advises clients on transactional matters including mergers, acquisitions, and joint ventures, as well as the establishment and operation of value-based organizations. His clients include physician groups and dental practices, dental support organizations, management services organizations, ambulatory surgery centers and surgery center management companies, nephrology practices and dialysis providers, skilled nursing facilities, hospitals, medical device companies, behavioral health companies and hospitals, as well as private equity sponsors in their platform and subsequent transactions.
In his practice, Nesko’s work includes negotiating and drafting transaction documents and counseling clients with regard to the legal aspects of day-to-day operations, including general corporate matters; the Stark law, federal Anti-Kickback Statute, state and federal fraud and abuse laws; self-referral, corporate practice of medicine/dentistry and fee-splitting prohibition, and matters related to provider-payor relationships. Nesko regularly lectures and writes on transactional and regulatory issues affecting a wide range of healthcare businesses.
Prior to joining Benesch, Nesko worked for a regional health system, where he gained valuable experience in matters concerning the Anti-Kickback Statute, Stark Law, and state fraud and abuse laws, as well as an in-house perspective of a large-scale corporate merger and restructuring project. Nesko also served as a legal extern at the Illinois Attorney General’s office, where he assisted in prosecutions of complex financial, tax, and revenue crimes. Nesko’s experience in both transactional and litigation practice of law provides him with a comprehensive perspective when guiding clients in structuring health care transactions within the complex regulatory and business environment.
Representative Experience
- Advising executives, operators and investors in value-based care and population management companies on regulatory and critical business and policy issues facing companies in this space.
- Advising healthcare providers, value-based care conveners, digital health companies and others on regulatory framework specific to value-based care arrangements and their intersection with established healthcare fraud and abuse laws.
- Advising clients on health regulatory, tax, real estate, and intellectual property matters related to the client’s integrated partnership of physician stakeholders engaged in value-based care arrangements with governmental and commercial payors.
- Provided strategic advice regarding demonstration programs sponsored by the Center for Medicare & Medicaid Innovation, including the Kidney Care Choices (KCC) Model and ACO Realizing Equity, Access, and Community Health (ACO REACH) Model (formerly Global and Professional Direct Contracting (GPDC) Model.
- Represented nephrology group practices in a strategic sale and long-term management agreement with Panoramic Health.
- Represented a leading national innovative behavioral healthcare organization in connection with obtaining regulatory approval (CON) to establish modernized replacement AMI hospital in Peoria, Illinois and assisting with licensing and certification.
- Performed health regulatory due diligence on a provider organization specializing in care for chronically ill patients subject to risk sharing agreements with private equity backed platform.
- Represented a whole person senior care in connection with an innovative risk-sharing arrangement with a large regional hospital chain.
- Represented private equity backed portfolio company in its acquisition of a Georgia based Hospice.
- Advised multiple physician practices in connection with risk adjustment audits, investigations and compliance matters with respect to their participation in Medicare Advantage plans.
- Represent telemedicine company in healthcare regulatory counselling in connection with domestic and international telemedicine and remote patient monitoring (RPM) arrangements.
- Advised a primary care physician practice on the establishment of an office based lab for the provision of infusion therapy services.
- Advised various providers and suppliers on regulatory flexibilities available under the value-based safe harbors to the Anti-Kickback Statute for care coordination and risk-sharing models.
- Negotiated and drafted numerous value-based and risk contracts between payors and health providers, ACOs and other value-based care entities.
- Negotiated and drafted numerous strategic partnerships for healthcare providers entering in risk sharing arrangements with private equity backed value-based care conveners.
- Extensive experience assisting clients in negotiating and navigating value-based care models and organizations such as:
- Managed Care Organizations
- Management Service Organizations (MSOs)
- Provider Sponsored Health Plans
- Independent Physician Association (IPAs)
- Accountable Care Organizations
- Clinically Integrated Networks
- Co-Management Arrangements
- Quality Incentive Payments
- Payments/Allocations for Shared Savings / Shared Risk Programs
- Bundled and/or Capitated Payment Arrangements
- Represented an LTC Facility operator in establishment of a joint venture with a national dialysis provider.
- Served as health care regulatory counsel for a New York-based private equity firm in its acquisition of a nationally recognized behavioral health provider specializing in clinical, educational and residential services for children and adults.
- Represented various nephrology practices in negotiations for their participation in CMMI’s CKCC Options of the KCE Model, a value-based care contracting model.
- Represented various physician practices in the establishment of value-based entities with private-equity backed value-based care providers.
- Represented a kidney care physician practice management company in value-based care arrangements and assisted in their market expansion.
- Represented founder dentists in establishment of a dental practice platform, acquisitions of additional locations and negotiation of the enterprise sale to a private equity fund.
- Represented a behavioral healthcare organization in connection with joint venture transactions with local behavioral health providers.
- Represented a private equity fund in its acquisition of a dental services organization.
- Represented public and privately-held physician management companies in the acquisition of physician groups.
- Represented nephrology practices in joint venture transactions (investment and divestment) with large dialysis organizations and dialysis providers.
- Represented nephrology practices in sale of practice transactions.
- Represented dialysis providers in transactions related to sale or purchase of dialysis facilities, including the sale or purchase of the related real estate.
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Represented nephrologists, nephrology practices and dialysis providers in negotiations of medical director agreements.
- Represented nursing homes in the negotiation of coordination agreements with dialysis providers.
- Advised multiple surgery center and physician clients on developing new service lines addressing state licensure, certificate of need and physician scope of practice laws to achieve strategic business plans.
- Developed code of conduct and compliance policies for a medical device manufacturer.
- Developed discount and rebate programs for medical device manufacturers.
- Provided compliance advice regarding outcomes-based (and value-added) sales models for medical device manufacturers.
- Advised providers and suppliers regarding compliance with federal and state fraud and abuse laws.
- Counseled providers and suppliers regarding satisfying Medicare conditions of payment, conditions of participation, conditions of coverage, and enrollment requirements.
- Advised physicians and other licensed professionals regarding complying with advertising and professional conduct restrictions.
- Counseled founder dentists in establishing a dental practice platform, acquiring additional practices, all the way through the sale of the platform to a private equity fund.
- Represented a private equity firm in investment in a dental services organization and related acquisitions of dental practices in multiple jurisdictions.
- Represented a national ASC development and management company in a series of acquisitions, dispositions and joint ventures.
- Represented a large health system in the disposition of its outpatient dialysis facilities.
- Represented multiple nephrology practices in establishing dialysis facility and vascular access center joint ventures.
- Represented a multistate physician practice in its sale to a private equity firm.
- Representation of various physician practices in corporate restructuring, physician recruiting and employment matters.
