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Long Term Care
Navigating the Legal, Regulatory, and Ethical Landscape of Extended Healthcare
Long Term Care (LTC) services are a vital part of the U.S. healthcare system—supporting aging adults, individuals with chronic illnesses, and those in need of daily medical or personal assistance. But beneath the compassionate mission of caregiving lies a complex web of federal and state regulations, reimbursement rules, and compliance obligations.
Whether you operate a skilled nursing facility, manage an assisted living community, or care for a loved one, you may be asking:
“Am I complying with all state and federal regulations?”
“What happens if our facility faces an inspection or lawsuit?”
“How do we protect against Medicaid fraud allegations?”
These are not hypothetical concerns—they are the everyday realities of long term care.
At SJKP LLP, our Long Term Care Practice provides comprehensive legal guidance to providers, administrators, and families navigating the intersection of healthcare law, government oversight, and patient care.
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1. The Legal Framework of Long Term Care
Where Compassion Meets Compliance
LTC providers operate under one of the most heavily regulated sectors in healthcare. Understanding the applicable laws and oversight bodies is critical to maintaining operational integrity and avoiding costly penalties. one of the most heavily regulated sectors in healthcare. Understanding the applicable laws and oversight bodies is cr
Federal Oversight and Key Statute
Long term care is governed by a network of federal regulations including:
- - The Social Security Act and Medicare/Medicaid regulations (42 CFR Part 483)
- The Health Insurance Portability and Accountability Act (HIPAA) for privacy and data protection
- The False Claims Act (FCA) governing fraud and billing misconduct
- CMS (Centers for Medicare & Medicaid Services) survey and certification requirements
SJKP LLP helps facilities interpret and implement these laws within their day-to-day operations—building a compliant foundation that supports patient care and financial stability.
State Licensing and Certification
Each state imposes its own licensing, staffing, and inspection standards on nursing homes and assisted living communities.
We assist clients in securing and renewing state licenses, responding to deficiency citations, and ensuring that facility policies align with local health department regulations.
Accreditation and Quality Compliance
In addition to regulatory compliance, many LTC providers seek voluntary accreditation through organizations such as The Joint Commission or CARF.
We advise on accreditation readiness, documentation, and corrective action planning to maintain quality assurance and institutional credibility.
2. Regulatory Compliance and Risk Management
Preventing Violations Before They Become Liabilities
Effective compliance programs are the backbone of lawful LTC operations. They protect against enforcement actions and strengthen patient trust.
Developing and Implementing Compliance Programs
SJKP LLP designs customized compliance frameworks that address:
- - Resident rights and care quality obligations
- Documentation and medical record accuracy
- Billing and reimbursement integrity
- Staff training, whistleblower policies, and reporting mechanisms
We help facilities establish internal compliance officers, conduct periodic audits, and maintain proactive relationships with regulators.
Government Audits and Investigations
LTC facilities face routine CMS surveys, state health inspections, and occasional DOJ or OIG investigations.
Our attorneys prepare clients for inspections, guide them through corrective action plans, and represent them during appeals or administrative hearings.
Responding to Enforcement Actions
When violations occur, timely response is critical. We defend facilities in cases involving:
- - Civil monetary penalties
- Denial of payment for new admissions
- Temporary management or license revocation
- Exclusion from federal healthcare programs
Our team negotiates settlements and compliance agreements that allow providers to maintain operations and reputation.
3. Medicaid, Medicare, and Billing Integrity
Safeguarding Reimbursement and Preventing Fraud Allegations
Billing compliance is one of the most sensitive and scrutinized aspects of long term care.
Improper documentation or coding errors can trigger fraud allegations or False Claims Act (FCA) investigations—even when unintentional.
Medicaid and Medicare Audit Defense
We represent LTC providers in audits by CMS, state Medicaid agencies, and Recovery Audit Contractors (RACs).
Our attorneys challenge improper overpayment demands, defend against extrapolated claims, and ensure that due process rights are protected.
False Claims Act and Whistleblower Cases
Whistleblower complaints under the qui tam provisions of the False Claims Act can expose facilities to massive penalties.
SJKP LLP defends providers accused of upcoding, medically unnecessary services, or misrepresenting patient care—conducting internal investigations and negotiating with the DOJ or OIG when necessary.
Compliance with the Anti-Kickback Statute (AKS) and Stark Law
Financial relationships with physicians, vendors, or referral sources must be carefully structured.
We help clients evaluate contracts, joint ventures, and marketing arrangements to ensure compliance with AKS, Stark Law, and Safe Harbor regulations.
4. Litigation and Crisis Management
Defending Facilities Against Lawsuits and Reputational Harm
Long term care facilities face increasing exposure to litigation—from resident injury claims to employment disputes.
SJKP LLP provides vigorous representation grounded in both healthcare law and litigation strategy.
Resident Care and Negligence Claims
We defend nursing homes and assisted living communities against allegations of neglect, abuse, wrongful death, or malpractice.
Our attorneys work with medical experts to evaluate claims, resolve disputes through mediation or arbitration, and protect facilities’ reputations in court.
Employment and Labor Disputes
Staffing shortages and workplace stress often lead to employment-related claims.
We advise on compliance with wage laws, discrimination statutes (EEOC), and whistleblower protections, ensuring facilities maintain lawful and ethical HR practices.
Crisis Response and Media Management
Negative press or regulatory actions can quickly erode public trust.
Our crisis response team coordinates communication strategies, manages investigations, and protects brand integrity while resolving underlying legal issues.
5. Family Rights, Guardianship, and Resident Advocacy
Balancing Facility Operations with Compassion and Legal Responsibility
Families play a central role in long term care decisions.
We provide legal support in disputes involving guardianship, power of attorney, and resident rights—ensuring ethical treatment and compliance with state resident rights laws.
Resident Rights and Facility Obligations
Federal law guarantees LTC residents the right to dignity, privacy, and freedom from abuse.
SJKP LLP advises facilities on drafting resident agreements, grievance policies, and complaint procedures that comply with 42 CFR §483.10 and related regulations.
Guardianship and Capacity Issues
When residents lack decision-making capacity, guardians or family members must act on their behalf.
We represent families in guardianship proceedings and counsel facilities on consent, disclosure, and liability management.
End-of-Life and Ethical Decision-Making
We assist clients with advance directives, living wills, and ethical care planning—balancing compassion, legal compliance, and institutional responsibilities.
6. Why Choose SJKP LLP for Long Term Care Legal Counsel
Compliance, Compassion, and Legal Excellence
At SJKP LLP, we understand that long term care is not just a business—it’s a moral and legal responsibility.
Our Long Term Care Practice unites regulatory insight, litigation strength, and healthcare industry experience to support providers in every aspect of compliance and defense.
We have represented nursing homes, assisted living facilities, and post-acute care organizations in licensing, audits, investigations, and litigation nationwide.
Our multidisciplinary approach integrates healthcare law, risk management, and ethics—ensuring that our clients deliver care with both compassion and legal precision.
From compliance planning to crisis response, SJKP LLP provides the clarity and confidence you need to operate responsibly in one of healthcare’s most regulated environments.
We don’t just defend long term care providers—we help them build trust that endures.
The information provided in this article is for general informational purposes only and does not constitute legal advice. Reading or relying on the contents of this article does not create an attorney-client relationship with our firm. For advice regarding your specific situation, please consult a qualified attorney licensed in your jurisdiction.
Certain informational content on this website may utilize technology-assisted drafting tools and is subject to attorney review.
