Our Firm’s Health Law Experience

Health Reform

Representative engagements in which The Health Law Consultancy attorneys furnished strategic legal counsel and support on:

  • Opportunities and options for health insurers to develop and participate in State health insurance exchanges.
  • Opportunities and issues for health organizations under Medicare and Medicaid shared savings, payer-provider accountable care and other value-based arrangements.
  • Formation, federal funding and implementation of CO-OPs—non-profit consumer operated and oriented health insurance plans.
  • Business expansion opportunities and options under the Patient Protection and Affordable Care Act for provider network management company.
  • Implementation of and compliance with the Patient Protection and Affordable Care Act health insurance market and product reforms.

Data Privacy and Security

Representative engagements in which The Health Law Consultancy attorneys furnished strategic legal counsel and support for:

  • Managing Federal and State data protection requirements for covered entities’ and business associates’ compliance programs, business associate contracts and data use agreements.
  • Compliance review and assessment of HIPAA-HITECH data privacy and security risk analyses, risk management plans and policies and procedures.
  • Data security breach risk assessment, response management, remediation and notification for covered entities and business associates.
  • Effective data security and breach notification liability insurance coverage for covered entities and business associates.
  • Implementing data privacy and security management for multi-payer claims database and for electronic health records.

Health Information Technology and Exchange

Representative engagements in which The Health Law Consultancy attorneys furnished strategic legal counsel and support for:

  • Implementing electronic health information exchange for health care providers, sponsored by non-profit organization for Medicaid pilot, including development and structuring of compliance, contractual and risk management framework and documentation.
  • Contractual and Anti-Kickback Law management for health plans implementing electronic health record and e-prescribing incentives for network providers.
  • Data privacy and security management for health industry trade associations developing electronic exchange protocols and operating rules for plan-to-plan personal health record transfers.
  • Managing Federal and State regulatory requirements for health plans initiating electronic and personal health records, e-prescribing and similar initiatives, including preparing data use and disclosure permission forms, enrollee communications, disclaimers and supporting contracts.
  • Data privacy and security and liability risk management for health plan’s implementation of electronic claims-based health records portal for network providers.

Transactions and Outsourcing

Representative engagements in which The Health Law Consultancy attorneys furnished strategic legal counsel and support for:

  • Negotiating and documenting outsourcing arrangements for health plans’ commercial and government prescription drug benefits business with pharmacy benefits management vendors.
  • Health plan’s provider connectivity initiative, including acquisitions, investments and development contracts.
  • Medicare benefits administration company regarding negotiations, relations and performance for outsourced pharmacy benefits management, medical benefits administration and medical management.
  • Structuring, negotiating and documenting sale of Medicare benefits administration company’s business to related entity.
  • Vendor contracting strategies and relations, federal contracting compliance and pre- and post-award contract form development and negotiation for health plan joint venture bidding for federal health benefits contract.

Medicare, Medicaid and Other Government Programs

Representative engagements in which The Health Law Consultancy attorneys furnished strategic legal counsel and support:

  • Structuring and creating urban Medicaid medical home initiative sponsored by non-profit organization, including negotiating and documenting arrangements with State Medicaid agency and health care provider participants.
  • Developing and implementing health plan joint enterprise concept for multi-State Medicare Advantage and Medicare Part D plans, including obtaining regulatory clarification from the Centers for Medicare and Medicaid Services (CMS) confirming joint enterprise contracting by CMS.
  • Overseeing compliance personnel and forensic consultants investigating pharmacy benefits management vendor’s Medicare Part D plan administration compliance failures.
  • Managing compliance lapses for Medicare Advantage and Medicare Part D plan sponsors, including negotiations with CMS to avoid penalties and sanctions.
  • Medicare Secondary Payer mandatory reporting for health insurers, including identification of multiple employer group health plans, communication with employer accounts and development of data collection processes.

Fraud and Abuse

Representative engagements in which The Health Law Consultancy attorneys furnished strategic legal counsel and support for:

  • Structuring options and seeking fraud and abuse waiver for non-profit organization submitting Health Care Innovation Challenge proposal to Center for Medicare and Medicaid Innovation.
  • Internal investigation of health industry vendor’s business relationship with customer under government fraud and abuse investigation.
  • Training and advising on Anti-Kickback Law safe harbors and fraud and abuse avoidance for health industry vendor’s management.
  • Private equity fund on disposition of investment in physician practice management company involved with physicians under government fraud and abuse investigation.
  • Restructuring health insurer’s investment in pharmacy benefits management vendor that had granted increased equity for increased volume or value of commercial and government prescription drug benefits business.

Antitrust

Representative engagements in which The Health Law Consultancy attorneys furnished strategic legal counsel and support on:

  • “Most favored nation” clauses in health insurers’ participating provider contracts.
  • Formation of provider network by non-profit organization to support medical home initiative for State Medicaid agency to improve access, coordination and quality for under-served urban Medicaid population.
  • Coordination with government antitrust agencies and public relations guidance for health insurers confronting concerted physician boycotts to increase reimbursement.
  • Coordination with government antitrust agencies and public relations guidance for health insurers facing aggregation of hospital system market power by hospital, ancillary provider and physician practice acquisitions.
  • Restructuring provider network products for provider joint venture offering payers contracted provider network.