Managed Care
Katten attorneys are involved in transactional, regulatory and contractual projects on behalf of integrated delivery systems, provider-based networks, disease management companies, trade associations, insurance companies and other managed care organizations.
Our attorneys combine their knowledge of regulatory law, insurance law, reimbursement, and corporate structuring and financing to serve as trusted legal advisors to managed care entities seeking to improve their market position through innovative alliances with health care providers and/or other entities that provide services to the health care industry. We design and implement virtually every type of provider-based integration structure, including MSOs, PHOs, IPAs and health care alliances, while analyzing the impact of the Stark Law, Medicare Fraud and Abuse, antitrust, licensure and insurance law considerations.
Our attorneys have the extensive experience and deep understanding of legal issues necessary to assist managed care clients in the development of new and innovative structures to access the managed care marketplace.
Professionals
|
Chicago
|
|
|
Chicago
|
|
|
New York
|
|
|
New York
|
|
|
Chicago
|
|
|
New York
|
|
|
New York
|
|
-
Represented insurance company in mediation over supply agreement with service provider. Effectively analyzed, valued and settled dispute for less than client authority after expending minimal fees and time through early negotiation and case analysis.
-
Represented consumer product manufacturer in arbitration with its distribution partner in dispute over fees incurred in $100 million per year supply agreement. Successfully argued that the agreement was not an unlimited cost plus arrangement but that fees
were subject to an agreed upon budget, leading to favorable settlement terms. As a result of this complex arbitration proceeding, our client was allowed to terminate a multiyear, multi-million dollar agreement before its term.
-
Analyzed and developed an HIPAA compliance program for a physician hospital organization which embarked on a process of marketing its services to past and present enrollees.
-
Conduct a complete compliance review for a physician hospital organization which analyzes tax exempt, fraud and abuse and Stark Law issues associated with its financing and operations.
-
Defended a consulting firm which provided a financial analysis utilized by an independent practice association to make personnel termination decisions from legal claims brought by the ousted employee.
-
Designed and developed numerous independent practice associations and physician hospital organizations which have implemented clinical integration programs to support a single signature contracting methodology.
-
Develop the clinical integration model and compliance requirements adopted by a non-risk bearing provider network to comply with FTC/DOJ clinical integration requirements.
-
Negotiate and document the repurchase of a hospital’s ownership interest in a physician hospital organization by the physician members.
-
Represented a large statewide managed care provider trade association in all aspects of its operations, member programs and legislative lobbying activities.