Health Law – Transactional, Regulatory and Legislative Matters (including Certificate of Need, Licensing and Medicare and Medicaid Appeals and Compliance); Insurance Law; Administrative Law

Bio

John P. Doyle, Jr. is chair of the firm's Health Law Practice Group and has been a major force in the creation and organization of the practice of health law in the State of Maine over the past three decades. John provides a broad array of legal services to a wide variety of health-related clients located in Maine, regionally and nationally. The providers he has counseled include regional and statewide hospitals and health systems, national, regional and statewide nursing facility and long term care organizations,  a wide range of other providers and practitioners, and their trade associations.

He has also handled many matters for regional and national health insurers, managed care carriers,  other payors and self-insured entities. He has argued before the Maine Supreme Court and the First Circuit Court of Appeals in many health-related cases including certificate of need, physician credentialing, Medicaid reimbursement, medical liability and board governance matters.

REPRESENTATIVE MATTERS

• Counsel to Mercy Hospital in securing an $85 million Certificate of Need from the Maine Department of Human Services to build a state-of-the-art facility on the Fore River in Portland that will house short-stay surgery, outpatient services and Mercy’s Birthing Center.
• Prevailed in a federal administrative law hearing before a Cleveland Ohio judge on behalf of a Maine osteopathic physician, Judy Hetzler Shedd, D.O.  The Judge concluded that the regional Medicare carrier had improperly recouped payments for hundreds of osteopathic procedures performed by Dr. Shedd and restored these funds to her. The court rejected the carrier’s denial, based on a 1994 local coverage determination.  The administrative law hearing was the third level appeal, following reviews by Massachusetts and Florida Medicare entities, where Dr. Shedd had been denied relief.
• Represented St. Margaret D’Youville Pavillion of Lewiston, part of the Sister’s of Charity Health System and affiliated with St. Mary’s Regional Medical Center, in obtaining Certificate of Need approval for major renovations, and sale of bed rights to an assisted living provider in a State-approved transaction that served to fulfill Medicaid budget neutrality requirements.
• Assisted St. Mary’s in securing State CON approval for $8.1 million expansion and renovation of its emergency department.  Now working on CON for  $25 million project to expand and upgrade the operating room, central sterile, lab and pharmacy facilities.
• Representing a number of providers on Medicare compliance issues and audit reviews by federal Office of Inspector General (“OIG”) and Maine U.S. Attorney’s Office. Negotiated terms of settlement and corporate compliance agreements.
• Counsel to Nationwide Health Properties, a health-care REIT with holdings in 40 states, in State approved acquisition of three Continuum Health nursing facilities for $39 million with sale-leaseback financial structure.
• Special counsel to Maine Hospital Association in proceedings before the Maine Superintendent of Insurance regarding the acquisition of the financially distressed Blue Cross and Blue Shield of Maine by Anthem. Secured several provisions in the approval order that addressed quality of care issues and assured continuation of adequate community provider networks.
• Represented a consortium of three Maine hospitals – Maine Medical Center, Southern Maine Medical Center and Goodall Hospital– in obtaining Certificate of Need approval for a radiation treatment facility in South Sanford, the Cancer Care Center of York County (CCCYC). Because two other hospitals were also seeking approval in a competitive review, the hearings and other proceedings before the Department of Human Services were hotly contested. Several court appeals followed in which the CCCYC has prevailed. 

PREVIOUS LEGAL EXPERIENCE

Prior to returning to Maine in 1979, he spent five years working in Washington, D.C., obtaining invaluable experience for his health law practice. During law school, he worked in the Office of the Legislative Counsel for the U.S. House of Representatives. He was then a legislative assistant to U.S. Senator William D. Hathaway, working on health-related issues including Federal cost-containment proposals before the Senate Finance Committee and Health Subcommittee of the Senate Labor and Human Resources Committee. At age 27, he was appointed Chief Counsel and Staff Director to the Senate Subcommittee on Alcoholism and Drug Abuse. In that position, he oversaw Federal programs with annual budgets of approximately $1 billion and coordinated the first Congressional hearing on the fetal alcohol syndrome.

PROFESSIONAL ACHIEVEMENTS

• Listed in the health lawyers’ section of The Best Lawyers in America continuously since the section originated in 1992.
• In 2003, he was appointed by Governor Baldacci to serve on the Committee on Cost Containment, State Health Planning and Regulation.
• Served on Board of Cheverus High School for seven years.  Served as Vice Chair of Board during planning, fundraising and construction of the Rev. John W. Keegan, S. J. Gymnasium.
• Board member, Maine Irish Heritage Center. Secured $900,000 insurance payment to fund reconstruction of Bell Tower at St. Dominic’s Church, National Historic Landmark and home of the Center.

Admissions

• Maine, District of Columbia, United States District Court for Maine, First Circuit Court of Appeals
• Member, American Health Lawyers Association
• Member, American Bar Association
• Former chair of the Maine State Bar Association's Health Law Section from its creation in 1985 through 1994

Education
J.D., Georgetown University Law Center, 1975
B.A., Yale University, 1972 (Cum Laude)