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Monitoring and Ensuring Quality Health Care

Seelig+Cussigh HCO LLC (S+C) provides health care consulting services to providers and governmental agencies. Our partners at David Hoffman and Associates are leaders at helping healthcare providers comply with regulatory requirements and ensuring patient safety through legal and clinical compliance. The Court and our wide range of clients praise the professionals of S+C for their skills and their ability to be an independent protector of patients and caregivers.


Chapter 11 Trustee

In Bankruptcy Cases where the Debtor is found to have not met their fiduciary and legal obligations to the bankruptcy estate, pursuant to Federal Bankruptcy Rules, the United States Trustee can appoint and United States Bankruptcy Court will then Order the Appointment of Chapter 11 Trustee. The Chapter 11 Trustee, as an independent third party assumes control over the assets and business operations of the debtor. The Chapter 11 Trustee is the fiduciary agent with an obligation to be fair to all parties to case and reports to the Court and interested parties on his actions. For health care debtors, that trustee must meet the additional challenges of mandated federal and state laws, regulations, and reimbursement rules.

After being appointed on March 12, 3013, Jerry Seelig assumed immediate control over the assets and business operations of a Home Care Nursing company employing over 150 home caregivers. Jerry immediately put in place financial controls and led a legal and administrative review to comply immediately with both bankruptcy law as well as to continue the debtor's full compliance with federal and state regulations and reimbursement rules. Jerry is working with owner/founder and her management team to improve management systems and to implement a strategy to meet the changing and demanding mandates of home care regulatory agencies. Concurrent with the administrative actions, Jerry is working closely with the Nursing director to continue high quality care and to maintain and expand the number of care professionals employed by the debtor.


Section 333 of the U.S. Bankruptcy Code provides for the appointment of a “PATIENT CARE OMBUDSMAN” (PCO) to monitor the quality of patient care and to represent the interests of the patients of the health care business:


Section 332 of the U.S, Bankruptcy Code provides for appointment of a "CONSUMER PRIVACY OMBUDSMAN" (CPO) in the event of court action sale of the debtor’s assets to assist the court in its consideration of the facts, circumstances, and conditions of the proposed sale or lease of personally identifiable information. The CPO reviews and reports to the Court on: (1) the debtor's privacy policy; (2) the potential losses or gains of privacy to consumers if such sale or such lease is approved by the court; (3) the potential costs or benefits to consumers if such sale or such lease is approved by the court; and (4) the potential alternatives that would mitigate potential privacy losses or potential costs to consumers.
Click for more about our work as CPOs

Case Summaries

Articles and News: Consumer Privacy Issues faced by Bankruptcy Professionals



A Health Care Bankruptcy provides special challenges and risks. S+C supports Creditor Committees, Trustees, Restructuring Professionals and other parties of interest in their efforts to understand fully the debtor’s operations.   Our team has the experience and skills to analyze information provided in operating reports and Plans of Reorganization.
Be it a hospital, surgery center, skilled nursing facility or any other provider, Health Care debtors generates revenues in a highly regulated industry.  Rules, regulations, and reimbursement rates are constantly changing and vary greatly from setting to setting.  Health Care debtors often have a significant share of their revenues from Medicare and Medicaid; this demands a strong knowledge of the rules governing those programs as well as extensive experience with the payers and the regulatory agencies.  Financial reporting and pro forma statement must be reviewed by professionals who understand the complex rules and standards for service that shape how much and when the debtor will or will not be paid for their services.

As an advisor knowledgeable and experienced in all segments of the health care industry we can to support your efforts by:

  • Evaluating the quality of patient care at each of the Facilities, including assessing the Debtors’ diligence in maintaining quality care.
  • Knowing what documents, reports, and other materials are available as well as having the skills to create and implement an evaluation/monitoring program that quickly and efficiently reviews key documents and interviews care givers and administrators.
  • Analyzing the Debtors’ ability to take all necessary steps to maintain licensing and accreditation.
  • Providing you with clear understanding of and the impact on the debtor’s operations of key Federal and State Privacy Acts including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and The Health Information Technology for Economic and Clinical Health (HITECH) Act.
  • Determining when access to patient confidential information is needed and implement HIPAA compliant strategies to appropriately access that information.
  • Reviewing state and federal legislation, which are bringing significant changes to health care reimbursement. Providing critical analysis to how these changes impact the Debtors’ current financial condition and its ability to both build and then implement strategic plans and financial projections.

 

David Hoffman & Associates
provides a proactive approach to compliance, viewing clinical and financial operations as well as clinical research programs through a legal lens to:
  • create a culture of compliance
  • conduct an evaluation to assess the degree of compliance
  • collaborate with the provider to develop a plan for compliance
  • identify organizational strengths and develop an action plan that helps organizations realize their fullest potential
Visit their website at:
www.dhoffmanassoc.com



The Professionals
Jerry SeeligRick Cussigh,  David R. Hoffmann


Jerry Seelig

Jerry@thepcos.com

Jerry Seelig established and is President of Seelig+Cussigh HCO LLC (S+C), which provides consulting services to health care providers and governmental agencies. Seelig has built and leads a team that possesses a wide range of expertise on the rules, regulations, and reimbursement rates that shape all types of health care providers. Jerry Seelig understands the Federal and State statutes that protect patient and consumer confidential information, set staffing and care quality standards, evaluate and monitor care givers and health facilities, and establish how services are reimbursed and audited.

For health care providers and skilled nursing facilities in bankruptcy or victimized by fraud, the S+C team brings both the experience and skills needed to monitor the care given to patients, protect the interests of the patients and caregivers, while serving as a truly independent voice to the Courts. The firm has worked closely with and has time and again earned the respect of attorneys for U.S. Department of Justice, the States’ Attorneys General, The Office of Inspector General for HHS, State Medical Boards and other regulatory and monitoring agencies responsible for health and senior care.

In March 2013, Jerry was appointed by the U.S. Trustee as Chapter 11 Trustee for the bankruptcy estate of Genus Home Health, a provider of home health services. Jerry has been appointed by the Office of the U.S. Trustee as the Patient Care Ombudsman (PCO) for ten U.S. Bankruptcy Court cases and as Consumer Privacy Ombudsman in three U.S. Bankruptcy Court cases. Mr. Seelig has also served as special health care advisor to the Creditors Committee in two Cases.

As PCO, Jerry has monitored a 200-bed safety net hospital and is now monitoring a rural critical access hospital with extensive out patient care services. In both Cases Jerry’s monitoring-reporting efforts involved him in all aspects of the daily operations of safety net care providers, which serve communities that are have few if any other access to acute care, emergency room services, and out patient services.

To report to the Court and in a wide variety of roles Jerry has become most knowledgeable on the State and Federal Programs that shape the funding of services provided by hospitals and clinics serving the poor. Jerry’s experiences in the safety net and on payment reform has brought him to work with local community clinics and other providers to assist in designing better delivery systems for the greatly expanding Medicaid delivery system.

Jerry has published with Richard Cussigh, “Vital Considerations in the Ombudsman Debate”, XXVII ABI Journal 8, 32-33, 66 October 2008 and with David Hoffman “PCO Appointment, Whose Facts?”, which was published in the March 2012 ABI Journal. In Payers and Providers and FierceHealth Finance Jerry has published articles on the Safety Net health care system, patient confidential medical information and hospital bankruptcies.

Jerry provides pro bono advisory services to Elizabeth Benson Forer the Chief Executive Officer and Executive Director of the Venice Family Clinic offering problem solving and networking for the largest free clinic in the United States. Building on his interactions with a large network of health care leaders, Jerry Seelig designed and implemented an interactive community for those facing the challenges of Healthcare Reform. The lead project is a newsletter (The Health Care Innovator’s Forum), which draws on a wide variety of people who are implementing Reform. Jerry is serving as publisher and lead writer for The Forum.

Jerry previously worked with Rick Cussigh at Transolutions where he defined and built a strategic alliance with a leading healthcare information systems vendor to work with hospitals and doctors’ clinics to design and implement new medical records systems. He negotiated and completed a marketing and technology alliance with the leading hospital software company, Cerner Corporation (NASDAQ:CERN). Jerry also worked with Cussigh to manage and complete a management buyout financed by five sub debt funds.

Jerry was Head of Business Development for TheraKine LTD. an early-stage drug company that employs patent-protected, drug technology, which are injected directly into the human eye or applied as topicals to cure major causes of blindness. Jerry has worked with Nifty after Fifty a personalized, and evidence-based senior health and wellness programs with centers in California, Texas, Nevada, New York, Virginia, and Arizona.

Over the past 30 years, Jerry has worked with a wide variety of health care providers, biotech, drug, and device companies, and served as a director or advisor to venture funds and not for profit organizations involved in health care. Jerry served as consultant and advisor to IngleWood Ventures, a San Diego based early stage venture fund specializing in pharmaceutical, medical informatics, and biotechnology companies.

Jerry received a Bachelors of Urban Planning Degree from University of Illinois, Urbana in 1971, a Masters degree with studies in Education, Economics and Social Policy from Harvard University in 1972 and Doctoral Studies in Social Work and Public Policy at the University of Chicago from 1977-80.

 

 



Richard Cussigh
Richard@thepcos.com

Richard (Rick) Cussigh has extensive experience in hospitals and other health care providers. Cussigh has been employed as consultant in the eight cases where Seelig served as PCO and was appointed jointly as Consumer Privacy Ombudsman (CPO) in one Case and employed consultant to the CPO in two cases. Cussigh has worked with all levels of management and staff at hospitals and numerous doctors’ clinics nationwide and has relevant experience in the management of medical records, Federal and State privacy regulations, and patient care monitoring systems.

Based on his extensive experience as an executive and entrepreneur, Rick is often called on the consult on cost accounting, operations management, and strategic planning issues. Rick is currently engaged in long-term advisory engagement in the senior living and insurance brokerage industries. Rick was the co-author of "Vital Considerations in the Ombudsman Debate”, XXVII ABI Journal 8, 32-33, 66 October 2008.

Rick founded and led Transolutions Inc, Lake Bluff, IL one of American’s largest and most innovative medical transcription companies. Within the Company, at the client hospitals, and working with the largest hospital software company, he was intimately involved in all aspects of analyzing, building and using management tools to record, evaluate and simplify health care delivery. Transolutions has provided transcription services to over 70 hospitals and has a US-based workforce in 45 states, which includes over 300 medical transcriptionists, clinicians, and technical staff. In January 2011, Rick successfully exited his investment in Transolutions, Inc. when it was acquired by Accentus a portfolio company of High Road Capital Partners.

Prior to that, Rick was Vice President, Chief Financial Officer, DonTech, Chicago, IL a $550 million partnership between Dunn and Bradstreet (now RH Donnelly) and Ameritech (now AT&T), serving Ameritech Yellow Page Customers in Illinois and Northwest Indiana) where he led finance, administrative and information technology organizations. At DonTech, he negotiated million dollar plus contracts and while meeting the owners’ demands for performance and financial results.

Rick received a Bachelor of Science, Business Administration in 1979 from Wayne State University, Detroit, MI, a Masters of Science in Taxation in 1988 Walsh College, Troy, MI, and a State of Michigan: CPA Certificate in 1982.

 


David Hoffman

David Hoffman
David@thepcos.com

David R. Hoffman has been employed as consultant to the PCO in both the Pacifica and Mohamed cases. David is President of David Hoffman & Associates, PC; a national healthcare consulting firm located in Philadelphia dedicated to assisting healthcare providers comply with regulatory requirements and ensuring patient safety through legal and clinical compliance. David’s firm has also been retained by government entities to represent them in healthcare related matters.

David was an Assistant United States Attorney in the Eastern District of Pennsylvania for 12 ½ years. He prosecuted healthcare fraud matters, both civilly and criminally. David prosecuted 13 cases involving long-term care facilities utilizing the federal civil False Claims Act to address failure of care. These cases, covering thousands of nursing home residents, resulted in Consent Orders and Settlement Agreements mandating, among other requirements, corporate compliance programs that address clinical issues, diabetes monitoring, nutrition and wound care standards, and pain management protocols. In February 2005, David resolved allegations against the University of Pennsylvania and Children's National Medical Center and three physician researchers emanating from a gene therapy study that ended with the death of Jesse Gelsinger.

In 1996 and again in 2001, David was awarded the Director's Award from the United States Department of Justice Executive Office for United States Attorneys for his work in protecting the elderly from abuse and neglect. He also was awarded the 1999 and 2005 Department of Health and Human Services Inspector General’s Integrity Award.

Prior to joining the U.S. Attorney’s Office, David served in the Governor’s Office of General Counsel as Chief Counsel for the Pennsylvania Department of Aging. At the Department, David was instrumental in drafting and implementing laws and regulations designed to protect the elderly. As a prosecutor, David successfully brought civil and/or criminal actions against physicians, managed care organizations, nurses, pharmacists, drug manufacturers, personal care home operators, educational institutions, hospitals and nursing homes. Before joining the Department of Aging, David was an Assistant District Attorney in Philadelphia, and also served as judicial law clerk to the Honorable Anthony J. Scirica in state and federal court.

David is a frequent lecturer for the American Health Lawyers Association and the Health Care Compliance Association. He has authored several published articles on quality of care and compliance. Dave received a Bachelor’s Degree from the University of Pittsburgh in May 1980 and a JD Degree from the University of Pittsburgh School of Law in May 1983.