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 Solutions—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 Solutions (MHS) is an interdisciplinary policy and business advisory division of Manatt, Phelps & Phillips, LLP, one of the nation's premier law and consulting firms. MHS 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 MHS professionals for leading expertise in healthcare coverage and access, healthcare information technology (health IT), healthcare financing and reimbursement, and healthcare restructuring. MHS also provides personalized services such as strategic and business advice, policy analysis and research, project implementation, alliance building/advocacy and government relations.
MHS 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 Solutions 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.
Achieving Continuity of Insurance Coverage for Lower-Income New Yorkers in 2014
Toward a High Performance Health Care System for Vulnerable Populations: Funding for Safety Net Hospitals
The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks and Considerations for States
Analysis of the Basic Health Program Options for New Hampshire
Federally-Facilitated Exchanges and the Continuum of State Options
Medicaid Managed Care: How States' Experience Can Inform Exchange Qualified Health Plan Standards
Implementing National Health Reform in California: Payment and Delivery System Changes
Medicaid Supplemental Payments: Where Do They Fit in Payment Reform?
HHS Proposed Rules on Exchange Implementation Requirements
Accountable Care Organizations in California: Programmatic and
Considerations for the Development of Accountable Care
Organizations in New York State
Implementing Health Homes in a Risk-Based Medicaid Managed Care
Medicaid's Role in the Health Benefit Exchange: A Road Map for States
Implementing National Health Reform in California: Opportunities for Improved Access to Care
"Revisioning" Medicaid as Part of New York's Coverage
Implementing Federal Health Care Reform: A Roadmap for New York State
The Impact of Federal Stimulus Funds on Community Health Centers in California
Spending Our Money Wisely
Closing Coverage Gaps: Improving Retention Rates in New York's Medicaid and Child Health Plus Programs
Coverage Gaps: The Problem of Enrollee Churning in Medicaid Managed Care and Child Health Plus
Implementing Express Lane Eligibility in New York State
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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