Health Care Litigation
U.S. health care is changing and so are the needs of your business. The McKenna Long & Aldridge LLP (MLA) cross-practice health care team focuses on protecting existing client interests and anticipating strategic opportunities. Bringing together attorneys and public policy advisors from the health care regulatory, public policy, government contracts, litigation, employee benefits, tax and corporate practices, MLA’s health care team uses their diverse experience to deliver comprehensive legal and public policy services at the intersection of business and government. Our clients range from providers and managed care organizations to pharmaceutical manufacturers and technology vendors.
Transactional / Contracting / Compliance
Our team’s deep knowledge in these areas includes helping clients address the health care regulatory issues that arise from corporate transactions and contracting with referral sources (such as physicians, physician groups, hospitals and other health care providers). Our team regularly represents our health care clients in corporate transactions, working in concert with our corporate attorneys to handle all aspects of joint ventures, mergers and acquisitions, divestitures and strategic alliances within the health care industry. We provide clients with comprehensive service in connection with such transactions, including advising on transaction structuring, risk assessment, drafting and negotiating transaction documents and all tasks associated with closing transactions and integration. As joint ventures, professional services 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 complex areas including regulatory, tax, intellectual property, and employee benefits, among others. We also involve our executive compensation attorneys to help ensure that compensation arrangements for key management are properly structured. In addition, we provide full service to our health care clients in connection with physician employment, contracting and recruitment, as all proposed relationships and payments must be examined carefully, in light of federal and state fraud and abuse and physician self-referral laws, to ensure compliance.
Compliance and Corporate Governance
The continuing implementation of health care reform initiatives of both state and Federal levels, as well as increasing budgetary pressures on Federal and state governments, make audits and investigations in the health care industry increasingly likely. Capitalizing on our health care regulatory, government contracts, litigation, corporate and public policy experience, our team helps clients develop proactive compliance strategies, avoid violations of federal and state laws and regulations and defend their interests in audits and investigations. In particular, our clients turn to us for issues related to:
- Reimbursement under Federal, state and private health care programs·
- Federal and state fraud and abuse laws
- Federal and state self-referral and fee splitting laws and regulations
- Medicare change of ownership requirements
- Licensing, accreditation and reporting requirements
- Human subject research regulatory compliance
- Responses to government and private audits and investigations
- Medicare cost report and fee-for-service appeals
- Responses to government reviews and medical documentation requests
- Medicare and Medicaid provider enrollment and conditions of participation
- Medicaid and state-funded medical program issues, audits and appeals
- Self-audits, refunds and voluntary disclosures
- Contract disputes with commercial payors
- Pharmaceutical pricing
In addition, MLA draws upon the existing work of our health care regulatory attorneys and the firm’s Corporate Governance Center to help boards of directors understand how increased scrutiny and regulatory changes will impact their industry and identify a proactive path to ensure they are positioned strategically in light of the current regulatory environment.
Health Insurance Exchanges
A key component of health care reform initiatives, Health Insurance Exchanges will impact almost every sector of the health care industry. MLA boasts a first-in-the-nation Health Insurance Exchange Team, a unique cross-practice initiative designed to help clients prepare strategically for the impact of health insurance exchanges on their business; specifically how Exchanges will affect providers, suppliers, insurers and employers.
In particular, MLA’s team is focused on the political and policy decisions driving implementation on the state level, including real-time tracking of state developments. In addition, the Health Insurance Exchange Team has completed research surrounding:
- Key state decisions necessary to implement an Exchange
- Eligibility determination processes
- Subsidy flow
- Functions of an Exchange, including a potential aggregator function
- Essential health benefits
MLA is home to the oldest, largest and most successful government contracts practice in the country. As such, our attorneys have significant experience with all federally-funded health care programs. In particular, we assist clients in developing government bids and proposals, forming joint ventures and teaming arrangements and drafting prime contracts and subcontracts. We are experienced in government contract performance matters, including interpreting contract requirements, protecting technical data and responding to audits.
In addition, our Government Contracts practice maintains long-standing and effective relationships with government payors, including the Department of Defense, Tricare and the Federal Employees Health Benefits plan, as well as with the Veterans Administration. Specifically, MLA has considerable experience assisting managed care organizations, carriers and intermediaries, pharmaceutical manufacturers, device manufacturers and other health care companies enter into contracts with federally funded health care and drug programs.
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