HEALTH CARE LITIGATION: DESCRIPTION

Health care is one of the most highly regulated, exceedingly complex, and rapidly evolving segments of today’s economy. This industry is constantly being shaped by factors such as information technology, cost containment, and government regulation. McKenna Long & Aldridge’s health care team is composed of a group of attorneys who focus primarily on health care clients and industry developments. Additionally, the team regularly utilizes the specialized knowledge and experience housed in multiple practice areas of the firm, including corporate counseling and tax matters, public health and pharmaceutical compliance, public policy and regulatory affairs, strategic advising and general counsel matters. Together, our attorneys work with diverse segments of the industry to provide unparalleled legal representation and advisory services to our clients on a comprehensive array of transactional, regulatory, and litigation matters.

Industry Providers

McKenna Long & Aldridge’s health care attorneys have an in-depth understanding of the increasing challenges and complex regulatory issues that can compromise the objectives of industry providers and participants upon being introduced into today’s complicated economic and political landscapes. Our team is equipped with the knowledge, experience, and insight needed to effectively help clients navigate through the obstacles resulting from regulation and change, both in the private and public sectors. Our clients have included hospitals; nursing facilities; assisted living facilities; ambulatory surgery centers; imaging facilities; ESRD facilities home health agencies; medical equipment providers; physician groups; health insurers; pharmaceutical companies; physician groups; insurance providers; and managed care companies.

Areas of Expertise

We are skilled at handling a broad spectrum of matters for our clients, ranging from the completion of basic transactions to the guidance and support necessary to successfully maneuver the more intricate and complex situations that often arise in the health care industry. The services offered by McKenna Long & Aldridge’s health care team clearly demonstrate the versatility of its members in skillfully confronting matters, whether transactional, regulatory, or litigation-specific.

Litigation Services

General Litigation

McKenna Long & Aldridge represents health care clients in a wide variety of general litigation in state and federal courts, as well as before administrative tribunals, throughout the country. We have a proven track record of successful representation for health care clients in complex litigation, class action suits, and multi-district litigation.  

ERISA and Employment Litigation

We have extensive experience involving claims of employment discrimination and in ERISA litigation. In the latter, we regularly address issues of health care plan interpretation, reimbursement and federal pre-emption. As with all of our litigation, we approach these matters with the goal of achieving the best practical result as efficiently and cost effectively as possible.

Antitrust Litigation

In our health care litigation practice, antitrust litigation is an important focus. In various cases, we have defended and brought antitrust claims involving hospitals and other providers and defended in government actions and investigations.

Federal Regulatory & Administrative Litigation

McKenna Long & Aldridge's litigators have extensive experience representing companies in regulated industries in matters involving federal and state constitutional, statutory and regulatory issues. We represent clients in a broad range of agency and court litigation involving challenges to federal and state government policies, rules and regulations. We also defend clients in a range of enforcement actions involving federal and state regulations as well as representing providers in investigations involving Medicare and Medicaid fraud, kickbacks, false claims and patient abuse.

Regulatory Services

Health Care Regulation

A thorough understanding of the regulatory environment is essential to our successful representation of health care clients. Our attorneys interact effectively with a variety of authorities, including CMS representatives and their attorneys, various United States Attorney‘s offices, and state regulators.

Public Policy and Legislative Advocacy

A thorough understanding of the regulatory environment is essential to the successful representation of our health care clients. Our attorneys and policy advisors interact effectively with multiple government offices and agencies, working consistently to build strong, strategic relationships to effectively position our clients to achieve their legislative and funding initiatives. Examples include:

• Central and Regional HCFA representatives and their attorneys
• OIG and Department of Justice
• Various U.S. Attorney’s offices
• State regulators with the Division of Medical Assistance, the Division of Health Planning, the Office of Regulatory Services, and the Department of Insurance
• State attorneys general

At the federal level, our attorneys and policy advisors have excellent working relationships with Congress, the White House and federal regulatory and administrative agencies. We boast an expansive capacity to advise health care clients on sophisticated policy and legislative matters, and we pride ourselves on our deep understanding of the broad spectrum of issues and areas of law that impact our health care clients. 

Certificate of Need, Accreditation, and Licensure

The Certificate of Need (CON) program is a regulatory process that requires certain health care providers to obtain state approval before offering certain new or expanded services.  McKenna Long & Aldridge has significant experience with the CON process and requirements associated with obtaining these certificates, along with the accreditation and proper licensing required in order to remain compliant with demanding health care industry regulations.

Compliance

Today’s health care industry faces a multitude of regulations resulting in complexities and challenges to organizations, providers, and patients alike. Failure to comply with such regulations brings real risks to the entity’s financial stability and professional reputation. McKenna Long & Aldridge offers clear counseling and adept understanding of the health care industry’s regulatory environment, thereby assisting clients to develop and implement a plan designed to ensure compliance in such regulatory areas as HIPAA privacy issues, Medicare and Medicaid, the stark laws and regulations and health care fraud and abuse.

Transactional Services

We represent health care clients in mergers and acquisitions, financings, private placements, real estate and equipment leases, and employment and medical staff matters.

Public Health and Pharmaceutical Compliance

Our Public Health team has one of the most experienced practices in the area of public health procurement and the marketing and sales practices of pharmaceuticals, biotech and medical suppliers. The group formulates training programs for the pharmaceutical and medical industries involved in public sector sales and counsels companies regarding compliance with medical regulations.

Mergers and Acquisitions, Joint Ventures, Structured Networks and Affiliations

The economic expansion and growth of regulatory complexities that the health care industry has experienced in recent years has resulted in a significant increase in corporate restructuring for both for-profit and not-for-profit health care entities. McKenna Long & Aldridge’s lawyers handle all aspects of consolidations, acquisitions, strategic affiliations and network formations customized to meet the varying needs and objectives of our clients.

We provide clients with comprehensive service in connection with mergers and acquisitions, including advising on transaction structuring, risk assessment, drafting and negotiating transaction documents, and all tasks associated with closing transactions and integration. As joint ventures and strategic alliances have continued to grow as favorable alternatives to traditional mergers and acquisitions, so too has our ability to respond to client needs by offering experienced counsel in tax, regulatory, intellectual property, employee benefits, among other complex transactions. We provide full service to our health care clients in connection with physician contracting and physician recruitment as well.

Tax-exemption Issues

In a climate that is increasingly concerned with organizational accountability, we regularly advise clients on relationships and ventures that might impact an organization’s tax-exempt status.  The health care group has experience in negotiating with state and federal revenue agencies and drafting private letter ruling requests to the Internal Revenue Service. 

Managed Care Contracting

We have broad experience in representing hospitals and other health care institutions in effective and appropriate managed care contracting, working with our clients in negotiating, analyzing and developing managed care contracts in a cost-effective manner. Our managed care know-how includes matters relevant to Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point-of-Service (POS) plans. We collaborate with our clients.

Representative Matters

McKenna Long & Aldridge prides itself on its ability to provide strategic, efficient, cost-effective services and solutions that are customized to meet the needs and objectives of its health care clients. Representative matters that the Firm and its lawyers have handled include:

• Successfully reorganized a network of sixty primary care physicians as part of an integrated delivery system formation with area hospitals in the Southeast.
• Structured, negotiated and documented tax-exempt hospital asset sale conversions involving Columbia/HCA Healthcare Corporation, Quorum Health Group, OrNda Healthcorp and Tenet Healthcase Corporation.
• Structured and provided corporate securities and tax advice in the formation of a Delaware LLC venture between a publicly traded hospital management corporation, a tax-exempt community hospital’s operating assets and more than fifty physicians’ practice assets in a simultaneous transfer and offering of securities in the joint venture.
• Successfully assisted a start-up specialty physician practice management company in the acquisition of physician practices in anticipation of an initial public offering.
• Represented a New England hospital in connection with deposition and document subpoenas by the Federal Trade Commission, and by the state attorney general in connection with a proposed hospital merger and integrated health insurance plan.
• Defended large home health care corporate group against federal and civil criminal fraud and abuse prosecutions, related bankruptcy proceedings, and the bankruptcy sale of home health operations.
• Sought and obtained IRS private letter rulings on various hospital sale, joint venture transactions, and restructuring, including the treatment of tax-exempt debt.
• Represented a publicly traded home health provider in its acquisition of approximately 100 home health agencies being divested by a hospital system.
• Represented Blue Cross Blue Shield of Georgia in its conversion from a not-for-profit to a for-profit corporation, an extraordinarily complex transaction requiring a change in Georgia Law.
• Represented Blue Cross Blue Shield of Georgia in the merger of its parent entity, Cerulean Companies, Inc., with an affiliate of WellPoint Health Networks, Inc., a publicly traded health care and insurance company that is the Blue Cross provider in the State of California.
• Defended national managed care insurer in Insurance Code enforcement action brought by state Insurance Commissioner.
• Defended national managed care insurer in defense of RICO, fraud, extortion and related claims in In re Managed Care MDL class action litigation in federal courts on behalf of provider class and medical associations; dismissed on summary judgment.
• Defended national small group health insurer in multiple actions (including class action) challenging premium and rate-setting methodology in Georgia state courts.
• Arbitrated claims alleging improper use of audit criteria by national managed care insurer to disallow and recoup hospital charges in excess of stop-loss thresholds.
• Defended purported medical malpractice claims asserted against Georgia HMOs; dismissed on ERISA preemption grounds.
• Defended self-funded employee benefit plans in purported tort and breach of contract actions regarding denial of benefits; dismissed on ERISA preemption grounds.
• Represented six Georgia hospitals in successful litigation over Medicaid reimbursement with the Georgia Department of Medical Assistance.
• Represented various health care providers in False Claims Act qui tam matters.
• Represented hospitals in certificate of need administrative hearings before the Georgia Department of Community Health, appeals before the State Health Planning Review Board, and in judicial review proceedings, involving new hospitals, new hospital service lines, additional beds, competitor’s strategies.
• Represented a major Atlanta hospital system in defense of a competitor hospital’s lawsuit claiming that it had been improperly excluded from managed care networks.
• Represented four Georgia hospitals in successful defense of class action lawsuits brought by uninsured patients challenging hospitals’ pricing and accessibility.