Legal services for healthcare private practitioners

There is nothing worse than having to pay an attorney for their time while you explain what you do before the attorney can help you.

That will never happen at Simons & Associates. We understand health care because we are also health care providers.

Meet Gwen Simons

Gwen Simons, Esq, PT, OCS, FAAOMPT founded Simons & Associates Law in 2007 as a law firm  that caters to the needs of health care providers in private practice.  As a physical therapist and former private practitioner herself, she understands that small practices need cost-effective legal and compliance solutions and has designed her services to meet those needs.  That’s why since 2007, she has become trusted legal counsel for 40+ physical therapy practices in Maine and 300+ entrepreneurial practitioners nationwide who have started telehealth, consulting and cash practices.  Gwen also currently serves as the Executive Director for the NorthEast Private Practice Network, working on legislation and regulations that promote appropriate reimbursement, fair contracts with payers and a level playing field for private practitioners to compete. 

Before attending law school at the University of Maine School of Law, Gwen started 3 private practices in the Louisville, KY area, provided contract services to a rural Kentucky hospital and provided work injury management and job analysis consultation services to large industries.  She has been a tireless advocate for physical therapists since graduating from PT school at the University of Kentucky in 1986 serving as the  President of the Kentucky Physical Therapy Association and the Maine Chapter, APTA.  She currently serves on task forces for the Private Practice Section (PPS), the Occupational Health Special Interest Group of the Academy of Orthopaedics and the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT).  As an expert physical therapist, she still performs functional capacity evaluations for personal injury, disability and workers’ compensation cases.

Whether you accept insurance, are a cash-based business or are developing intellectual property,  we can help.  Our mission is to make sure private practice survives and thrives!   

Services We Offer

Business Formation and Buy/Sell Agreements

Simons & Associates Law provides consultation to health care providers who are starting a private practice, growing and developing their practice, bringing equity owners into their practice and selling their practice. We’ve assisted clients in writing service proposals, developing legally defensible consulting services, negotiating service contracts with facilities, and developing fitness, wellness and other services as an extension of their traditional medical practice.

Review of Payor Contracts

Contracts with private insurers are becoming more and more complicated. Many contracts are “Silent PPOs” that allow the payer to sell their preferred provider network to any other payer that the provider may already have a separate contract with. Providers can risk their business by signing every contract that comes their way without first obtaining legal counsel on what the contract really means for the provider’s reimbursement. Simons & Associates can review your provider contracts and assist you in negotiating terms that appropriately protect you as well as the Payer.

Malpractice and Liability Insurance Consultation

Does your malpractice insurance cover the services you provide? You may be surprised to find out it doesn’t. Professional malpractice coverage may be limited to tasks that are within the profession’s scope of practice. Since practice acts vary from state to state as well as the interpretations by licensure boards, the same insurance plan could provide different coverage in different states. Non-traditional services may not be covered by your malpractice plan at all. If you need help determining whether you have the right policy for your practice, Simons & Associates can help.

Medicare Denials, Recoupments & Appeals

Medicare and Medicaid audits are on the increase. Government payers are looking for any opportunity or excuse to recoup payments already made to you for services you legitimately provided. Even harmless, minor omissions in clinical documentation in a small number of records can be extrapolated to result in a repayment demand of thousands (even hundreds of thousands) of dollars. Auditors, however, frequently make mistakes by misinterpreting or misapplying CMS rules. If you are the victim of an audit, you need legal counsel.

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