Healthcare

Areas of Focus 

Our counsel is as broad as the industry itself, including specialized matters unique to healthcare providers and general business concerns common in any highly competitive environment. The following summarizes our primary areas of counsel.

Antitrust
We help health care 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 health care 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.

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Corporate Reorganization
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.

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Emerging Healthcare Technologies
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.

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Financing
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.

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Fraud and Abuse, Restrictions on Referrals
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.

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Healthcare Delivery Systems
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:

• Acquisition of and affiliation with (through ownership or by contract) other health systems
• Acquisition of ancillary and other service providers
• Development of tax-exempt medical clinics and other physician practice management organizations
• Reorganization of corporate structures to respond to the financial and operational needs of a multi-entity system

Because Manatt has wide-ranging financial institution contacts, we also facilitate our clients' access to the capital necessary for successful completion of service expansions.

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HIPAA
We regularly advise health care 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 health care arrangements and the designation of hybrid entities.

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Legislative and Administrative Law
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.

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Litigation
Manatt's 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 significant healthcare regulatory and corporate practice also allows our litigation clients to obtain legal counseling and advice when seeking to structure their operations to avoid litigation down the road.  The fact that we have generally addressed these issues before and do not need to learn the law as we go along, not only gives our clients the benefit of experienced advisors, but offers considerable cost savings as well.   

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Long-Term Care
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.

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Managed Care
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.

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Manatt Health Solutions
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:

• Works collaboratively with the client to establish a trusted relationship and reach workable solutions.
• Preserves the confidentiality of the client to serve its best interests.
• Engages the best team of people in the Firm with the right breadth and depth of expertise to meet the client's needs.
• Takes a senior management approach to integrate solutions across the different functions and processes of a business or organization.
• Applies fact-based analysis to provide robust and practical solutions for our clients.

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Medical Staff Relations/Peer Review
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.

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Medicare/Medicaid Reimbursement
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.

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Not-for-profit Organizations
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).

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Other Healthcare Areas
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:

• Employment and benefits issues, such as compensation of physicians and executives, regulatory compliance (ADA, OSHA, ERISA)
• Environmental concerns, particularly regarding hazardous medical waste and needle safety
• FDA regulation of pharmaceuticals and medical devices
• Insurance matters involving coverage and subrogation, directors and officers liability, risk management and third party payor contracting
• Patient rights concerns focusing on bioethics, confidentiality of medical records, government access to books and records, AIDS treatment counseling, controlled substances, informed consent and rights to emergency medical treatment
• Rate review and rate setting

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Pharmaceuticals and Biotechnology
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.

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Physician Arrangements and Organizations
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.

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