As managed care continues to grow and evolve, our clients remain focused on delivering high-quality and cost-effective healthcare in an environment that is subject to heightened scrutiny and enforcement. The attorneys in our multi-disciplinary Managed Care practice have the knowledge and experience necessary to advise clients on the full spectrum of business, legal, and compliance issues impacting the industry. We partner with our clients to navigate this complex regulatory environment and to mitigate risk.
Our attorneys bring federal agency and private defense experience to enforcement and litigation matters involving, for example, the False Claims Act (FCA), Anti-Kickback Statute (AKS), Stark Law, administration of the Part D drug benefit, and Medicare Advantage risk adjustment. We advise companies on internal and governmental investigations involving the U.S. Department of Justice, Centers for Medicare and Medicaid Services, Office of Inspector General for U.S. Department of Health and Human Services, and others.
Our practice also draws on the firm's deep bench of healthcare regulatory and reimbursement attorneys for matters important to managed care organizations. We provide compliance counseling focused on holistic assessments of enterprise risk to develop mitigation strategies. In privacy and cybersecurity, we assess risks and offer program design or enhancements as well as advising on data breach response, including conducting investigations and developing notifications for affected individuals. We also advise on strategic transactions including mergers and acquisitions and joint ventures, as well as contract negotiations, bankruptcy and restructuring, and antitrust considerations. We assist clients with responding to governmental inquiries, including subpoenas, and self-disclosures to federal and state regulatory agencies.
We counsel a variety of clients, including:
- Health plans
- Pharmacy benefit managers
- Pharmacies
- At-risk providers
- Electronic health record organizations
- Other vendors interacting with plans and providers in the managed care space
Our interdisciplinary team has significant experience advising clients on issues and laws relevant to the industry, including:
Regulatory & Compliance
- Medicare/Medicaid compliance, including risk adjustment data validation (RADV) audits
- Compliance program assessment, development and implementation
- Provider-fraud detection and remediation
- Quality metrics, including HEDIS/STARs reporting
- Management services organization (MSO) relationships
- Overpayment Rule Telehealth
- Affordable Care Act
- Medical loss ratio
- No Surprises Act
Investigations & Disputes
- Medicare Advantage risk adjustment
- Antitrust
- Benefits and coverage
- Labor and employment
- IT vendor disputes
- Provider disputes
Privacy & Cybersecurity
- Cybersecurity risk assessment, program design, and enhancement
- Data breach response, including investigation and notification
- Creation of incident response plans
- Analysis of adequacy of protections for data on cloud
- Review of data-sharing arrangements involving PHI and other regulated health data
- Health information exchanges
- HIPAA and state privacy laws
Transactions
- Mergers, acquisitions, joint ventures, and other transactions
- Deal due diligence
- Contract negotiations
- Antitrust considerations
- Bankruptcy and restructuring
- Tax structuring
