Mark S. Kopson

Mark S. Kopson chairs Plunkett Cooney's Healthcare Industry Group and became Of Counsel to the firm in 2006.

Mr. Kopson represents numerous healthcare facilities, professional practices, physician-hospital organizations, integrated delivery systems and managed care entities in the State of Michigan and throughout the United States. He has extensive experience and expertise in the areas of managed care contracting, including both negotiation and dispute resolution, as well as HIPAA, Stark and Anti-kickback compliance and agency investigation response. His practice also includes the formation and counseling of joint ventures and the sale and purchase of commercial entities and real estate.

An accomplished author and sought-after speaker, Mr. Kopson frequently presents educational programs to various legal and healthcare industry groups.

Representative Client Work

• Successfully negotiated managed care participation agreements for HMO, PPO, Medicare and Medicaid products, with local, regional and national payors on behalf of an integrated delivery system comprised of five hospitals and over 500 physicians, resulting in substantially increased reimbursement and significant additional contractual protections for client providers.
• As Co-counsel for an integrated multi-provider network, prosecuted a multi-million dollar arbitration claim for breach of a managed care contract, resulting in mid-seven-figures settlement in client's favor.
• Helped a physician practice successfully challenge the pay-for-performance payment and related public “score” proposed by one of its major payors, resulting in additional performance-based bonus payments and an improved quality ranking in the payor’s publicly distributed materials.
• Negotiated and drafted HMO joint-venture documents on behalf of a 2,300-member physician network.
• Conducted Fraud and Abuse, Stark Act, HIPAA, and CLIA compliance analysis on behalf of physicians, clinics, ambulatory surgery centers, laboratories, imaging facilities, and DME suppliers, and assisted those clients in structuring their arrangements to maximize profits and compliance.
• Counseled a PHO regarding potential anti-trust exposure posed by its existing payor contracting arrangements and its anti-trust compliance options, and subsequently helped the client form and successfully implement a legally compliant “messenger model.”
• Counseled and drafted all documents for the formation of 300-member physician organization and negotiated its subsequent formation of, and entry into, a physician-hospital organization to maximize its managed care viability.
• Represented a de-participated physician against a major insurer and HMO in State and Federal court litigation and subsequent arbitration proceedings, resulting in full-participation status and a six-figure monetary award to client.
• Successfully resolved a PHO client’s six-figure dispute with an HMO regarding the financial risk settlement under their participation contract through facilitative mediation.
• Assisted numerous health care providers in the formation of professional corporations, limited liability companies and general business corporations, including the drafting of entity formation and governance documents and consensus-building among diverse participants.
• Represented a group of five physicians in the termination of their hospital employment agreements, their purchase of practice-related assets from the hospital, the formation of a new practice entity, the lease of office space, and the launch of their successful independent practice.
• Assisted foreign-owned entity in overturning an unfavorable arbitration award through litigation, thus allowing client to negotiate a more favorable out-of-court settlement
• Negotiated the sale of a multiple-physician, family medicine practice to a major hospital system, including all related transaction documents, real estate lease, physician employment agreements, and personal services contract, thus allowing retiring client physician to enjoy the well-deserved fruits of his decades of practice.
• Assisted Kentucky group of anesthesiologists in their transition from independent practice to a hospital-employed group, including the successful negotiation of assets and administrative services arrangements and multi-year physician employment agreements.
• Successfully defended client specialist physician against her former employer’s allegations of breach of a Non-compete Agreement and in the formation and successful launch of her independent specialty practice.

Professional Affiliations

• Oakland County Bar Association
• State Bar of Michigan (Business Law and Health Care Law sections)
• American Bar Association (Business Law, Health Law, and Law Practice Management sections)
• American Health Lawyers Association (Practice Groups: HMOs and Health Plans - chair, Managed Care Affinity Group, Physician Organizations, Fraud and Abuse, Antitrust, Health Information and Technology, and Hospitals and Health Systems)

Publications and Lectures

• “Contractual Negotiations Between Payors and Providers,” presented at the 2007 Law Conference for Health Plans, Insurers and Providers; The Westin Diplomat Resort, Hollywood, Florida; May 9-11, 2007
• “Good News and Bad News for Physicians: Compliance Enforcement Developments,” Principal Health PHO Newsletter, July 2006
• “Reimbursement of Physician Services,” Representing Physicians Handbook, American Health Lawyers Association, 2005 (chapter editor)
• “Application of Federal Antitrust Laws to Healthcare Providers,” Laches, September 2005
• “Healthcare Antitrust Update,” Principal Health PHO Newsletter, September 2005
• “Good News from the Government…No, Really,” Principal Health PHO Newsletter, May 2004
• “Avoid Antitrust Violation When Determining Payment for On-Call Coverage,” Credentialing & Peer Review Legal Insider; January 2004 (contributing consultant)
• “Hot Issues in Recent PO and PHO Managed Care Negotiations,” Health Care Weekly Review, March 6, 2002
• “Six Steps to a Successful Practice Buy-in,” Medical Economics, February 24, 1997 (contributing consultant)
• “Stark I Final Regulations: Implications for Health Care Providers and Suppliers,” The Health Lawyer, Special Edition, August 1995 (co-author)

Publications

• Application of Federal Antitrust Laws to Healthcare Providers

Speaking Engagements

• 2008 - Medical Records Law in Michigan Seminar

News

• Kopson among featured speakers at national podiatric meeting