Chair, Healthcare Divisionemail
A Strong Team to Address Challenging Issues Manatt is home to one of the top healthcare law and consulting practices in the United States. Consistently ranked as one of the nation’s top firms in healthcare by Chambers USA, ten of our healthcare attorneys were individually ranked as leading lawyers and three received its highest rating.
With decades of experience and 80 professionals dedicated exclusively to healthcare clients, Manatt is one of the most trusted advisors to government, not-for-profit organizations and private companies seeking to understand and adapt to the new imperatives of health reform. We work broadly across the healthcare industry, representing state policymakers and agencies, payers and healthcare providers, foundations, associations, and product and service vendors.
What distinguishes us from other healthcare practices is our ability to handle issues at the intersection of law, policy and industry practice that help our clients’ management teams define and implement complex strategies. Our team includes leading attorneys, consultants, project managers, analysts and policy advisors who have held executive positions with federal and state agencies, associations, major healthcare institutions, and leading consultancies. As a result, we are able to design effective solutions and make actionable recommendations that give due consideration to the practical realities of public policy, applicable laws and regulations, operational sustainability and business imperatives.
To help our clients stay current on the issues that are transforming the healthcare industry, we maintain a federal and state information service that provides updates and timely information on emerging developments in payment policy, delivery system reform and insurance reform.
A World-Class Transaction Practice
Manatt’s extensive experience in healthcare transactional work has placed us at the center of many important transactions in recent years. We are often called upon to address issues related to transaction planning and negotiation, due diligence, regulatory (including antitrust, Medicare and Medicaid audits, investigations, compliance and certification, anti-kickback issues, and licensing and accreditation), and debt and corporate restructuring. Our healthcare attorneys handle the full range of transactional matters, including hospital and health system mergers and acquisitions, provider integration transactions, financings of all types, joint venture transactions, and workout and turnaround projects.
At the Forefront of Healthcare Litigation
Our healthcare litigators have been involved in virtually every significant litigation issue of the past several years, including rescission, capitation, vicarious liability and ERISA preemption. We have defended and won significant class actions for both provider and payer clients. Our class action victories have resulted in the making of new laws impacting consumer health insurance rates, provider reimbursement, antitrust issues, nursing home staffing and the freedom of entities to publish information measuring provider performance, and protecting consumers and supporting their choices.
Intimate Knowledge of Healthcare Regulations
Hospitals, health plans, clinics and other healthcare services are subject to a bewildering array of federal, state and private regulations from multiple branches of CMS, as well as the FDA, IRS, FTC, DOJ, OIG, state attorneys general, state Medicaid agencies, state licensing agencies and private accreditation bodies, such as The Joint Commission. Our professionals have extensive experience dealing with these agencies, including as staffers before joining Manatt. Our professionals work daily with the underlying regulations in matters of interpretation, related business transactions, agency contact, regulatory comment and enforcement matters. We have successfully provided clients with comprehensive and practical understanding of the regulations and the regulators, as well as helped them find sensible solutions that can be applied in the real world.
First-Class Consulting Practice Our healthcare consulting practice—Manatt Health—provides in-depth understanding of the complexities of government health insurance programs and federal and state financing mechanisms. This understanding, combined with knowledge of payer requirements and provider delivery systems, enables us to develop innovative and strategic solutions for both public and private sector clients.
We are engaged in a broad range of cutting-edge initiatives, including the design and implementation of health benefit exchanges, health information exchanges, and new models for the payment and delivery of healthcare services through accountable care organizations, medical homes and other hospital-physician-payer collaboration approaches. Our team has the deep technical knowledge of government programs—including proficiency in the eligibility, benefits, financing and administration of Medicaid and CHIP, and in the interpretation and implementation of Medicare reimbursement and policy requirements—to help you successfully negotiate the intricacies of government healthcare policy. Currently, Manatt professionals are leading complex strategy engagements for state governments, major insurance companies, major health delivery systems and leading pharmaceutical companies.
We help healthcare professionals properly structure and operate provider contracting arrangements (the alphabet soup of IPAs, JOAs, PHOs, PPOs and many others) that effectively compete in today's market without violating antitrust guidelines. Our attorneys also advise hospitals and medical centers on mergers and acquisitions, making sure they are positioned to avoid investigation or litigation of antitrust claims over delivery of healthcare services. Our team members include the author of the first book ever published on the application of the antitrust laws to the healthcare industry, and our lawyers have spoken and published frequently on this topic.
As pioneers in applying corporate reorganization principles to healthcare providers, our health law attorneys routinely have advised both financially stable and financially troubled healthcare organizations, as well as lenders, on corporate reorganization and financial restructuring. Typical of our work is Manatt's representation of the California Department of Managed Health Care (the regulatory body that oversees all managed care in California) in connection with large healthcare Chapter 11 proceedings such as In re MedPartners Provider Network, Inc., In re KPC Global, and In re Maxicare.
Our attorneys represent emerging medical technology and life sciences companies, assisting them with their entity structure, intellectual property licensing and protection, employee contracting, public and private financing, and mergers and acquisitions. We have organized and obtained financing for a variety of healthcare technology start-ups, taken them through successive rounds of venture capital financing, formed joint venture and licensing arrangements with larger companies, represented them in their initial public offerings and subsequent financings, advised them regarding securities compliance issues and represented them in mergers valued in the billions of dollars. Manatt also represents venture capital funds that invest in medical technology and life sciences companies, helping them with organizational, investment and operational issues.
Having one of the nation's leading financial institutions practices, Manatt is experienced in handling a variety of financing transactions for our healthcare clients. Our attorneys serve as counsel for bond issuers and underwriters in a wide range of tax-exempt transactions as well as public offerings of equity securities, including limited partnership interests. We also arrange financing through various health facility authorities, secure federally insured mortgage loans, obtain venture capital, and assist with franchising arrangements and advance debt refunding transactions.
Manatt attorneys have in-depth experience with the complex and often confusing laws that govern healthcare provider billing practices and ownership and referral relationships. Because fraud and abuse and self-referral concerns involve intense regulatory scrutiny and enforcement, we offer comprehensive advice regarding the structure of transactions, design and implement corporate compliance programs, conduct internal investigations, and assist in voluntary disclosures.
Manatt professionals represent healthcare entities and individuals in a variety of criminal, civil and regulatory proceedings, and in all phases of government investigations and prosecutions involving fraud and abuse allegations. We have comprehensive experience in this difficult law enforcement environment, and consistently obtain very favorable outcomes for our clients. Our lawyers help clients respond to search warrants, grand jury and administrative subpoenas, and civil investigative demands; represent individuals before grand juries; and handle pre- and post-indictment plea negotiations, proceedings, and sentencing.
Using our extensive knowledge of the competition and cost pressures facing healthcare providers, we help them to position themselves for survival by enhancing quality and expanding services. Our attorneys can analyze healthcare markets and formulate strategic plans that help clients grow by establishing new programs or business combinations. The comprehensive range of service-expanding transactions that we guide includes:
Because Manatt has wide-ranging financial institution contacts, we also facilitate our clients' access to the capital necessary for successful completion of service expansions.
What does the future hold for U.S. healthcare?
President Obama's re-election guarantees that implementation of national healthcare reform will proceed, and makes it likely that the ACA's expansion of private and public sector coverage will take place on time in 2014. According to the most recent estimates from the Congressional Budget Office (CBO), this means that, starting in 2014, nine million Americans will get their health insurance through health insurance exchanges, with that number growing to 25 million by 2017. It will also mean that, in 2014, millions of people will join Medicaid and the Children's Health Insurance Program's (CHIP) current 35 million beneficiaries. In 2014 alone, these changes will add approximately $51 billion to the federal government's healthcare spending to bring it to nearly $950 billion. Read more
We regularly advise healthcare providers on their responsibilities to protect the privacy of patient health information under the Health Insurance Portability and Accountability Act (HIPAA). Our clients for HIPAA compliance counsel include hospitals, community health centers, mental health clinics, residential treatment programs, dialysis clinics, HMOs, insurance companies and trade associations, as well as a diverse group of "business associates" such as information technology firms, medical device marketers, IPAs and disease management companies. A key part of our compliance work involves conducting training sessions for provider personnel, so that they handle information requests and record security in compliance with the law. As part of this training, our attorneys analyze where improvement in records privacy is necessary, draft privacy and security policies and procedures and prepare business associate agreements and privacy notices. Manatt has also provided strategic advice on HIPAA compliance issues as they involve the relationship between affiliated entities, the creation of organized healthcare arrangements and the designation of hybrid entities.
Reflecting our extensive experience at the highest levels of government healthcare policy regulation, we are uniquely positioned to help shape federal and state health policy in ways that advance the interests of our clients. Our attorneys combine hands-on understanding of healthcare operations, the regulatory environment and the legislative process to craft, advocate and implement far-reaching solutions to complex policy problems. As part of maintaining a forceful presence in the regulatory and legislative arenas, we negotiate on behalf of clients before the U.S. Congress, state and local governments and quasi-governmental agencies. We also regularly scrutinize governmental actions at all levels, and help clients formulate and present testimony and other position statements that guide and shape the policymaking process.
Manatt’s full-service Healthcare Litigation practice is committed to protecting the interests of providers and payors. We offer an unparalleled combination of deep understanding of the complex and dynamic healthcare field, strong relationships with, and high-level access to, the regulatory, legislative, and enforcement entities and officials critical to your business, and the ability and experience to take complex matters to trial.
Our ability to provide outstanding service to our litigation clients is enhanced significantly by our extensive healthcare regulatory and corporate practices. Our experience in the nation’s two most innovative and complex healthcare law environments - California and New York – when combined with our respected government advocacy capabilities in the District of Columbia and major state capitals, means we can provide healthcare clients with unsurpassed legal and business advice. We have been at the forefront of virtually every major provider and health plan litigation issue in California in the past five years. Read more
We understand the new political pressure that has greatly intensified the already tough enforcement environment for nursing homes, and help nursing home operators throughout the country deal with the often subjective and inconsistent enforcement of federal and state licensure and certification requirements. When our clients face investigations and sanctions from regulators (including terminations from the Medicare and Medicaid programs, bans on admission and civil monetary penalties) we are frequently successful at ending the action by negotiating a favorable settlement. When that is not possible, our attorneys have successfully defended long-term care providers in courts and administrative agencies throughout the country in survey enforcement disputes as well as proceedings alleging fraud and abuse violations. We are also effective advocates for long-term care providers who are faced with elder abuse lawsuits.
Our healthcare attorneys help managed care providers, employers, and health maintenance organizations, including various state managed care programs, deal with operational issues and the widespread legislative efforts to police managed care decision-making and increase the scope of coverage. We have participated actively in the development of HMOs, PPOs, and insurance ventures, including multi-state HMO operations. As a result, we can help any HMO client with issues involving regulatory compliance, provider and subscriber relations, and quality assurance.
Manatt Health is an interdisciplinary policy and business advisory division of Manatt, Phelps & Phillips, LLP, one of the nation's premier law and consulting firms. Manatt Health helps clients develop and implement strategies to address their greatest challenges, improve performance and position themselves for long-term sustainability and growth. The healthcare landscape is rapidly evolving in both the public and private sectors. Clients can look to Manatt Health professionals for leading expertise in healthcare coverage and access, healthcare information technology (health IT), healthcare financing and reimbursement, and healthcare restructuring. Manatt Health also provides personalized services such as strategic and business advice, policy analysis and research, project implementation, alliance building/advocacy and government relations.
Manatt Health professionals' breadth of experience and interdisciplinary approach attract a wide range of for-profit and nonprofit clients in both the public and private sectors.
Manatt Health applies a core set of principles to every engagement:
Manatt attorneys provide a full range of legal services in the critical areas of medical staff peer review and governance. Our experts handle all phases of internal administrative actions and litigation involving credentialing of practitioners, as well as denial, suspension, reduction and termination of privileges and membership. We also advise clients on their reporting responsibilities to state medical boards and the National Practitioner Data Bank.
The range of staff relations issues that we handle is comprehensive. Our healthcare attorneys draft and revise medical staff bylaws, rules and regulations, and policies and procedures governing practitioner membership, privileges, obligations and rights, medical staff leadership and functions, and medical staff relations with hospital administration and the governing body. In special situations, we help clients deal with impaired or disruptive practitioners, implement closed staffing arrangements and hospital-based physician contracts, address emergency department coverage issues, and educate physicians on medico-legal issues.
Manatt healthcare industry attorneys have provided reimbursement counsel since the inception of the Medicare and Medicaid programs. We help clients interpret regulations and policies promulgated by federal and state agencies, enabling them to maximize reimbursement payments and representing them before Medicare and Medicaid agencies in disputes and investigations.
Manatt lawyers regularly counsel tax-exempt healthcare systems, hospitals, and health plans, providing general advice to non-profit boards of directors, and also representing them in litigation. We provide expert-witness services in the areas of fiduciary obligations of officers and directors of non-profit corporations, and offer specific counsel on charitable trust law and officer, director and trustee liability. We have special experience in handling healthcare facility alliances and conversions from non-profit to for-profit status, in particular transactions involving transfer of non-profit hospital assets (which are subject to Attorney General regulatory review).
Manatt's multidisciplinary national practice gives our healthcare clients access to focused legal counsel on any other concerns that arise in the course of daily operations. Examples of areas in which our healthcare attorneys work with colleagues throughout the firm include:
Our attorneys represent pharmaceutical and biotechnology companies in all of their organizational, financial and licensing activities. We have organized and obtained financing for biotechnology start-ups, taken them through successive rounds of venture capital financing, formed joint venture and licensing arrangements with larger pharmaceutical companies, represented them in their initial public offerings and subsequent financings, advised them regarding securities compliance issues and represented them in mergers valued in the billions of dollars. In our regular representation of bio-pharmaceutical clients, we provide counsel in the human relations, real estate, contracting, litigation and regulatory issues common to all businesses, as well as those unique to the industry. We have represented non-profit organizations in their contracting and licensing activities, and formed university consortia for the achievement of significant biotechnology projects.
As traditional methods and structures of physician practice continue to evolve, we help physicians in all aspects of organizing, managing, and reorganizing medical practice groups. Our healthcare lawyers handle the most complex organizational matters, including developing alternative legal structures for multi-physician practices, and forming independent practice associations and other effective vehicles for contracting with managed care organizations and hospitals.
We also help physician groups with day-to-day operational issues and contract negotiations. Having worked extensively with physicians, hospitals, and hospital systems, our lawyers offer creative counsel on the complex relationships and issues physicians have with payors and other healthcare providers. We are fully experienced with joint hospital-physician relationships, and have worked with hospitals and hospital systems to develop integrated delivery of health services, including hospital-sponsored practice management services organizations and tax-exempt medical foundation clinics.
AAMC Produces Landmark Report on Academic Health Systems for the Future
For the Association of American Medical Colleges (AAMC), Manatt advised on and coauthored the landmark 2014 report "Advancing the Academic Health System for the Future," which articulated a vision and recommendations for academic health centers as they seek to transform into systems responsive to the changing clinical environment and able to continue to invest in teaching and research missions. Manatt worked closely with the AAMC Healthcare Affairs Advisory Panel of Deans, CEOs and Practice Plans to assess the landscape for academic medicine, complete in-depth profiles of leading organizations, prepare the panel report, and develop a companion self-assessment tool.
Continuum Health Partners Merges with Mt. Sinai
Manatt advised Continuum Health Partners, a New York City nonprofit health system composed of three hospitals (Beth Israel, St. Luke's Roosevelt and NY Eye and Ear Infirmary) in the formation of a new, integrated health system with Mt. Sinai Hospital and the Icahn School of Medicine at Mt. Sinai. The combined entity—called the Mount Sinai Health System—is now one of the nation's largest nonprofit health systems.
Blue Shield of California and Anthem Blue Cross Fund Integrated Data Exchange
Manatt represented Blue Shield of California in the formation of a joint venture with WellPoint Inc.'s Anthem Blue Cross to fund California Integrated Data Exchange, better known as Cal INDEX, projected to be one of the nation's largest health information exchanges. Together, Blue Shield and Anthem Blue Cross are spending $80 million on the nonprofit.
The Commonwealth Fund Examines States' Efforts to Promote Integrated Care
Manatt authored a white paper for The Commonwealth Fund that examines states' efforts to promote integrated care delivery as part of their efforts to deliver high-quality, cost-effective care to Medicaid beneficiaries with comorbid physical and behavioral health conditions ("State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment"). The Medicaid expansion authorized by the Affordable Care Act (ACA) brings greater import to these efforts, as millions of uninsured low-income adults, many at increased risk for behavioral health conditions, gain coverage and states are required to provide behavioral health services and meet federal parity laws. State efforts to ensure that Medicaid beneficiaries have access to integrated care, however, are hindered by a fragmented behavioral health system that is administered and regulated by multiple state agencies and levels of government, and by purchasing models that segregate behavioral health services from other Medicaid-covered services. Drawing on a review of the literature and interviews with diverse stakeholders, this report explores strategies states are deploying to address or eliminate system-level barriers to integrated care for this medically complex and high-cost Medicaid population.
Regional Collaborative of Healthcare Providers and Plans Advised on HIPAA Issues
Manatt led the development of a regional collaborative of healthcare providers and plans for the purpose of implementing the HIPAA Administrative Simplification transactions. The project included developing detailed ROI analyses for each of the seven provider and payer member organizations, a consortium governance and funding model, the technical architecture design for transaction integration and real-time transfer of HIPAA transactions between consortium members, and a detailed project plan and cost estimates for implementation.
Medical Device Manufacturer Executes Reimbursement Strategies to Support Launch
Manatt is assisting a medical device manufacturer with execution of reimbursement strategies to support the launch of its recently FDA-approved radiopharmaceutical. Reimbursement support includes analysis of clinical evidence to guide development of coverage policies, preparation of New Technology applications to receive Medicare reimbursement in hospital outpatient departments, and identification of reimbursement challenges and opportunities under the Affordable Care Act.
Hoag and St. Joseph Health Advised on Merger
Manatt advised Hoag Memorial Hospital Presbyterian and St. Joseph Health, two of the most prominent healthcare systems on the West Coast, on an innovative affiliation that seeks to significantly improve the delivery of healthcare in the local communities served by these long-standing institutions. The organizations have formed an integrated regional health system that includes six Southern California hospitals, an expansive physician network, and numerous outpatient and urgent care facilities in Orange County and the High Desert. Their shared vision includes taking action to fix fragmented systems of care, greatly improve access for the underserved, and deliver on the goal of making the region among the healthiest in the country. Manatt represented the parties with respect to state and federal regulatory and antitrust matters and advised on key corporate and governance provisions for the members of the affiliated group.
National Health Insurer Forms Multiple JVs to Create ACOs
Manatt's healthcare team has structured multiple joint ventures between a national managed care health insurer client and leading healthcare systems throughout the United States. The purpose of the JVs is to create accountable care organizations (characterized by a payment-and-care delivery model) through which our client can employ its insurance and IT capabilities to help providers better manage the cost and quality of care.
Kaiser Commission on Medicaid and the Uninsured Prepares Issue Brief on DSRIP
Manatt and The Kaiser Commission on Medicaid and the Uninsured prepared an issue brief on Delivery System Reform Incentive Payment (DSRIP) programs, which are increasingly being used by state governments across the country to promote sweeping payment and delivery system reforms. Part of broader Section 1115 Waiver programs, DSRIP initiatives provide states with significant funding that can be used to support efforts by hospitals and other providers to change how they provide care to Medicaid beneficiaries. Titled "An Overview of Delivery System Reform Incentive Payment (DSRIP) Waivers," the brief examines the similarities and differences among California, Texas, Kansas, New Jersey, Massachusetts and New York across key elements of DSRIP waivers, including the goals and objectives of DSRIP initiatives; eligible providers, projects and organizations; allocation of funds; data collection and evaluation/reporting; and financing of DSRIP waivers.
Academic Health System Develops Health IT Strategy
Manatt advised a large academic health system on its health information technology strategy, including the design of a new portfolio-based IT organization model to improve resource alignment and focus, an application plan that consolidated systems and prioritized investments in new capabilities, a technology plan to improve systems' performance and availability, and a five-year capital and operating budget.
Long-Term Care Coalition Advised on Legislative and Regulatory Strategy
Manatt founded and provides legislative and regulatory advocacy services to the New York State Coalition of Managed Long-Term Care and PACE Plans, a consortium of 18 nonprofit, provider-sponsored managed care organizations that coordinate care of chronically ill, nursing home-eligible New Yorkers. As part of our engagement, we obtained approval of a proposed rule to mandate their enrollment, if they require more than 120 days of community-based long-term care services. The rule immediately became the centerpiece of the state's Medicaid Redesign of long-term care services. We also assisted with the implementation of the new initiative, as well as the development of a new, capitated model for managing the care of dual eligibles.
Hartford HealthCare Counseled on Antitrust Issues
Manatt served as antitrust counsel to Hartford HealthCare, which includes Hartford Hospital (an 867-bed regional referral center that is one of the largest teaching hospitals and tertiary care centers in New England) and three community hospitals, with respect to its affiliations with the Hospital of Central Connecticut and with Backus Healthcare System, also based in Connecticut. In the midst of sweeping change in healthcare, these affiliations created a fully integrated healthcare delivery system for the region.
New Hampshire Assesses Basic Health Plan Options
On behalf of the Endowment for Health/Health Strategies of New Hampshire, Manatt partnered with Mercer Government Human Services Consulting to publish an assessment of the Basic Health Plan (BHP) option for the state of New Hampshire. The team was tasked with presenting a suite of options for state policymakers and stakeholders to consider as New Hampshire contemplates whether to implement the BHP. The report includes an evaluation of the financial feasibility of the BHP option in the state and an analysis of policy options for the use of federal subsidies above the cost of the BHP. It also examines the implications of adopting a BHP for a state health benefit exchange.
Major Pharmaceutical and Device Manufacturer Analyzes Alternative Pricing Models
Manatt was engaged by a large pharmaceutical and medical device manufacturer to conduct comprehensive research and analysis of alternative pricing models used by pharmaceutical manufacturers in their contracts with health plans and delivery systems. Manatt identified alternative pricing options, worked with the client's leadership to consider how the options might become a component of its commercial plans, and provided lead pricing options and strategic recommendations to the company.
California HealthCare Foundation Highlights Efforts to "Free the Data"
Recognizing the significant role that publicly accessible and usable data can play in improving the quality and efficiency of the healthcare system, the U.S. Department of Health and Human Services (HHS) and certain states have launched initiatives to increase the amount of new healthcare data available in the public domain. Manatt Health Solutions—together with the Center for Democracy & Technology—prepared an issue brief titled "Strategies for Safeguarding Patient-Generated Health Information Created or Shared Through Mobile Health Devices" for the California HealthCare Foundation highlighting efforts by HHS and states to "free the data" and outlining the benefits to California should the state follow suit.
Ranked Nationally in Tier 1 for Healthcare Law 2011–2016
2014 Awards for Excellence Winner in Healthcare
Ranked for Healthcare Law 2007–2015
Ranked Nationally in Tier 1 for Healthcare: Health Insurers 2012–2015
Ranked Nationally for Healthcare: Service Providers 2012–2015
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