Our health care team consists of experienced attorneys and consultants who guide our clients through the maze of organizational and regulatory complexities that define the health care field. We provide expertise in a variety of areas, including: Medicare/Medicaid, compliance, privacy, fraud and abuse, insurance regulation, ERISA, care improvement programs, litigation, labor and employment, and health care transactions. Several of our attorneys have served as in-house counsel to both hospitals and health plans, providing us with unique experience and perspective in meeting our clients’ needs. Our team combines its knowledge of cutting edge health care trends with a specialized consulting and legal practice that services the diverse needs of a variety of health care organizations.
Health Care Transactional, Regulatory and Litigation Support
Regulatory ComplianceOur team can assist in understanding, assessing and developing recommendations and strategies for compliance, regulatory and risk management/mitigation issues, which are critical in implementing new programs, in day to day operations, and when entering into contractual relationships. We have assisted many clients in structuring transactions, operations and product offerings to address compliance with state and federal requirements, including licensure, certification and accreditation requirements, and fraud and abuse laws and regulations.
TransactionsWe provide a variety of transactional services to our clients within the health care industry, such as hospitals and physician groups, specialty providers, health plans, insurers, third-party administrators, for-profit and not-for-profit organizations, medical device and technology companies, and other health industry organizations seeking to expand or change their business relationships. We have assisted our clients in complex transactions involving group purchasing contracts, acquisitions, joint venture arrangements, significant health information technology purchases, and the development of standard contracting templates for our health care clients to utilize in contracting with providers and vendors, and for use within RFP processes.
Privacy and SecurityOur expertise in privacy and security spans HIPAA, HITECH, ARRA, Gramm-Leach-Bliley and state laws. We have extensive experience with the breadth of issues facing providers, insurers, plans, vendors and others that are now regulated by privacy laws. Our clients include complex national organizations including insurers, health plans, providers, disease management companies, trade associations and vendors to these organizations. We are knowledgeable in the full scope of issues including business associate relationships and contracting, data breaches, implementation of ARRA and on-going HIPAA issues. Our counsel to clients also extends to state issues that are often intertwined with federal requirements. We have the expertise and knowledge to assist with privacy related legal and compliance matters that may arise in a variety of contexts.
Government Programs (Medicare, Medicaid and other government-funded programs)We are well versed in Medicare compliance trends including marketing guidelines, fraud and abuse, specific compliance matters, relationships between participants in public programs and implications of health care reform. We have extensive experience with Medicaid contracting matters and operational considerations for health plans in complying with state mandates and requirements. We have provided legal and compliance advice for the complete array of organizations participating in public programs – hospitals, physicians, Medicare Advantage, Part D and SNP plans. Also, we have supported clients undertaking audit activities for state and federal programs. Our expertise allows us to identify potential issues and remediate concerns that arise for providers and plans that participate in public health care programs.
Health Plan and Provider Contracting & CredentialingWe offer extensive business and regulatory experience to health plans and providers on a wide variety of contracting, medical staff governance, and privileging and credentialing issues.
Regulatory Investigations and InteractionsWe have extensive experience counseling clients who work in the highly regulated health care industry on interactions with State and Federal regulatory agencies, such as CMS, the Office of Inspector General, State Medicaid authorities, State Departments of Insurance and State Attorneys General. We also have extensive experience representing all types of health care providers in state licensing board actions and investigations. Members of our Firm’s health care legal team have served in the State Attorney General’s Office, and our enforcement side experience gives us unique and valuable insight in representing clients before state and federal regulatory agencies and licensing boards.
Health Care Litigation (claim disputes, administrative actions, commercial matters)In partnership with our experienced litigation group, we provide litigation services for a range of legal issues that are unique to the health care marketplace. We also offer general defense work for more common business risks.
Education and TrainingOur lawyers and consultants frequently provide training and updates to our clients on topics such as HIPAA privacy laws, Stark compliance, Risk Mitigation and other legal and consulting topics. These services are provided under a variety of arrangements.
ERISA and Benefit Plan Compliance and LitigationWe represent and provide counsel to insurers, self-funded benefit plans, and claims administrators on a variety of issues unique to their business. Our expertise includes:
- Representing insurers, plans and claims administrators against claims for payment of employee plan benefits brought under ERISA in federal courts.
- Representing insurers against claims for breach of contract and bad faith in state courts.
- Preventive counseling to insurers, third-party administrators, outside medical consultants, and employers on the substantive aspects of ERISA, plan requirements, breach of contract, unfair claims practices and bad faith.
- Providing advice to insurers, self-funded plans and third-party administrators on establishing and maintaining appropriate claims review processes.
Health Care Consulting
Medical ManagementWe help health plans and providers design and implement medical management programs that save money and improve quality.
Care CoordinationWe evaluate programs for efficacy and assist with the development of care transition and other evidence based approaches that work for specific populations.
Health Care AnalysisWe help health plans and providers analyze data so they can spot opportunities to improve organizational financial health, identify quality issues, and determine the ROI on medical management and other programs.
Recovery Audit Contractor ReadinessWe help hospitals prepare for the RACs by reviewing charts for medical necessity and working with physicians and nurses to improve decision-making.
Product Development and OperationsWe assist clients in establishing strategic and long-range product roadmaps. In addition, we help to develop processes, frameworks, tools and organization for project planning and assessment, business case evaluation, project prioritization, change management, portfolio management and executive reporting that usher new products from ideation to launch.
AccreditationWe help health plans and providers attain NCQA and URAC accreditation for pharmacy, case management, utilization management and other areas.
Community BenefitWe help organizations and local governmental authorities perform assessment and develop plans for meeting the needs of vulnerable populations within the communities they serve.
Employee Benefit DesignsWe help employers and health plans create industry leading benefit designs that maximize consumer ownership, wellness and cost containment techniques.
Health Information TechnologyWe advise healthcare organizations of all sizes on how to make more effective use of their IT assets, people and organizations.
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Stephen K. Warch
Shareholder and Co-chair, Health Care Law & Consulting Practice GroupP 612.305.7663
Kristin L. Austrum
Bradley J. Betlach
William D. Hittler
Alison J. Johnson
Donald M. Lewis
Careen H. Martin
Kerri A. Neitzel
Wynne T. Turner
