Health Care

Regulatory Practice and Medicare and Medicaid Experience and Capabilities
Our lawyers represent health care providers on Medicare and Medicaid payment issues. We have extensive experience in handling Anti-Kickback, Stark, and other fraud and abuse issues relating to hospitals, physicians and managed care organizations, and are knowledgeable regarding guidance and the enforcement policies of the Office of the Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS).

We have represented hospitals in connection with the Justice Department's investigation of Medicare reimbursement matters, Anti-Kickback and Stark issues and the civil False Claims Act. We assisted clients in establishing and implementing corporate compliance programs. We represent both physician and hospital clients in matters relative to Medicare and Medicaid billing violations (administrative, criminal and civil).

Our lawyers represent clients in EMTALA matters, including OIG hearings, negotiations with the OIG and administrative appeals. We have assisted clients in complying with TJC requirements, and in drafting corporate and medical staff bylaws. We advise clients frequently regarding consent issues and medical record-retention issues.

With regard to state law matters, we advise clients regarding certificate of need laws, Louisiana hospital service district laws and licensure issues. Our health care lawyers stay abreast of Division of Medicaid developments and frequently advise clients regarding Medicaid issues, including payment issues.

We closely monitor Medicare developments and frequently comment on proposed rules on behalf of our clients. We routinely represent clients interested in Medicare provisions in the federal budget bills. We have represented clients' interests to congressional delegations, and we stay abreast of both federal and state health care legislative developments. Because we have excellent relationships with CMS and OIG officials, we are in a position to obtain an authoritative answer to issues that the published rules and regulations may not address.

We handle administrative appeals before the Provider Reimbursement Review Board and have represented groups of hospitals regarding the Medicare disproportionate share statute and other payment issues.

Our lawyers advise clients about the proper structure of provider relationships to avoid antitrust violations, including physician hospital organizations and independent physician associations, implementing messenger model guidelines and counseling providers and rendering opinions in connection with issues regarding collaboration on prices, division of markets, issues of exclusivity and Robinson-Patman questions. Additionally, we assist clients in developing and implementing corporate compliance programs regarding antitrust issues.

Managed Care Experience and Capabilities
Our health law lawyers represent health care clients in a variety of managed care matters, including:

• Assisting clients in establishing and operating managed care organizations, including HMOs, PPOs, MSOs, PHOs and IPAs
• Assisting providers in applications to market Medicare Select products
• Negotiating provider contracts with, and for, hospitals and individual physicians, as well as with group practices, including a variety of payment arrangements, such as discounted fee-for-service fees, withholds and capitated arrangements
• Developing a variety of contractual arrangements with subscribers and TPAs, including full-service third-party administration and contracts for more limited services, including enrollment, claims payment and utilization review
• Assisting in the development of pharmacy arrangements for managed organizations
• Assisting in licensing TPAs and UR companies.

Additionally, our lawyers are familiar with the ERISA issues involved in establishing managed care plans, the scope of preemption, the requirements for SPDs and related documents, the risks of "bad faith" liability and the preemption doctrine as it relates to possible "bad faith" liability.

We have prepared medical staff bylaws for various managed care organizations and hospitals, including policies and procedures with respect to credentialing and delineation of privileges. We are familiar with the issues that typically arise in managed care organizations with regard to credentialing and re-credentialing, delineation of privileges, deselection, and other matters including antitrust issues. We have participated in numerous administrative hearings and litigation.