Katten attorneys act on behalf of health systems, physicians, multi-provider networks, disease state management companies, trade associations, insurance companies and other managed care organizations in network structuring and formation, clinical integration, antitrust and contracting projects. We represent virtually every type of provider and managed care network, ranging from provider-sponsored accountable care organizations (ACOs) to unique affiliations among insurance companies and health systems. Dental and vision programs, third-party administrators and internet-based service providers also seek our counsel regarding the development and operation of, and participation in, Medicare, Medicaid and commercial managed care programs.
Our attorneys combine their knowledge of health care regulatory parameters, insurance law, reimbursement, corporate structuring and antitrust to help clients improve their market position through innovative alliances with health care providers, commercial payors and other entities that provide services to the health care industry. We advise on clinical integration strategies and the development and operation of virtually every type of provider network, including ACOs, management services organizations (MSOs), physician hospital organizations (PHOs), independent practice associations (IPAs) and health care alliances.
Katten’s Health Care team provides the full array of services necessary to structure and operationalize successful provider networks and innovative managed care alliances. We prepare governance documents, committee charters, compliance programs, participating provider agreements and unique payor-provider arrangements. We help draft ACO, Bundled Payment Initiative and other program participation applications, advise on participation requirements and facilitate regulatory filings. We provide counsel on incentive distribution methodologies, medical management programs, marketing materials, provider outreach, contracting strategies and credentialing plans. Our attorneys are well versed in a variety of reimbursement methodologies, including shared savings, bundled payment, pay-for-performance, capitation, subcapitation, multiple risk pools and withhold incentives.
Drawing on considerable antitrust strength, we structure and restructure provider networks to ensure that they are sufficiently integrated to pass muster under the antitrust laws. Our attorneys design each integration structure based on careful analysis of the impact of the Stark Law, Anti-Kickback Statute, licensure and insurance law considerations, as well as current market dynamics.
Clients also rely on us for guidance in ERISA matters and regulatory issues including antitrust, fraud and abuse, physician self-referral, fee splitting, corporate practice of medicine, licensure, consumer protection, mandated benefits and confidentiality of information.