Health Care and Insurance

In today’s highly volatile and heavily regulated health care environment, attorneys practicing in Glast, Phillips & Murray’s health industry practice group have extensive experience representing and defending health care providers, health insurers, health maintenance organizations, managed care organizations, health plan sponsors, healthcare payors, medical management companies and other service organizations, pharmaceutical companies, PBMs, medical device and equipment companies, health care technology companies and a diverse array of other health industry clients to fashion, implement and defend pragmatic risk management and operational strategies.

The health industry clients that our attorneys have represented include not-for-profit and for-profit integrated delivery systems, hospitals and health care systems, physician/hospital organizations and other joint ventures, ambulatory and outpatient surgery centers, healthcare clinics, ambulance companies, home health agencies, skilled nursing care facilities, assisted living facilities, ambulatory care facilities, psychiatric treatment facilities, chemical treatment facilities, preferred provider organizations, provider service organizations, demand management and utilization management companies, health maintenance organizations (HMOs), managed care organizations (MCOs), management services organizations (MSOs), independent practice associations (IPAs) and other physician organizations, preferred provider organizations (PPOs) and other networks, medical schools and other educational facilities, physicians, physical therapists, occupational therapists, audiologists, nurses and nurse practitioners, chiropractors, dentists, veterinarians, other health care practitioners, insurers, health care industry consulting organizations, and a diverse array of other health industry clients.

Health and managed care industry practice experience is broad reaching and includes experience with the following: • HIPAA privacy and other Federal and state law medical confidentiality, privacy and security matters; • The design, formation and administration of health care and managed care entities and relationship including the formation of professional associations, for profit and non-profit health care related entities, integrated delivery systems, PHOs, MSOs, PPMs, 501(a) organizations, HMOs, PPOs, and other health care entities; • Operational matters affecting health care and managed care entities; • Managed care matters including managed care contracting, capitation, stop-loss and other reinsurance arrangements, utilization management, credentialing, claims administration procedures, and other related concerns; • Re-engineering of health care and insurance entities including workforce realignment or downsizing, corporate reorganization and restructuring, and other related concerns; • Design, administration, documentation, licensure, and defense of managed health, workers’ compensation and disability programs, products, and services; • Health care and insurance regulatory compliance; • Exclusive provider and vendor contracting; • Licensing, credentialing, and other staff privileging matters, including peer review, HCQIA and state mandated fair hearing and due process, and other staffing and personnel matters; • Contracting including exclusive provider contracts, employment contracts, independent contractor agreements, outsourcing, indemnification, HIPAA business associate and other confidentiality agreements, insurance, administration agreements, hospital service agreements, HMO and PPO contracts, provider agreements, and other staffing and managed care agreements; • Electronic medical records and other health industry data concerns; • Telemedicine; • Reimbursement, billing and collections, and claims payment and audit practices and procedures including claims and reimbursement requirements under HIPAA, state clean claims and prompt payment, ERISA and other group indemnity and managed care health programs, individual insurance arrangements, Medicare, Medicaid, CHAMPUS, worker’s compensation and other programs and benefit coordination, subrogation and assignment matters; • EMTALA, STARK, fraud and abuse, anti-referral, corporate practice of medicine, OSHA, and other health care regulatory matters; • DNR and other medical directives, privacy, and other patient rights matters; • Prevention and defense of government investigations, litigation and other disputes related to health care, managed care, health care employee benefit plans, occupational injuries, and other tax, labor and insurance matters; • Corporate compliance including Federal Sentencing Guideline and other compliance program, audits, disclosures, defense and settlement and other practices; • Bond, grant and other health care financing matters; • Medical malpractice defense; • White collar defense of health industry clients; • Academic medicine matters; • Legislative and regulatory reform including advice and representation of foreign and domestic governmental institutions regarding public policy matters and advice and representation of health care providers, employers and employee benefit plan sponsors, health care and managed care organizations, insurers, government officials, and others before Federal and state legislators and regulators in connection with legislative and regulatory reform and enforcement initiatives and health industry related public policy matters.

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