Managed Care Contracts: Medicare and Medicaid Considerations for Providers

Mr. Domsten advises clients on federal and state healthcare regulations, including the creation of compliance programs and the resolution of instances of identified noncompliance. He is experienced in evaluating risks under the False Claims Act, appealing alleged overpayments, defending against government investigations concerning Medicare and Medicaid billing, and addressing self-disclosure requirements under the Stark Law and Anti-Kickback Statute. Mr. Domsten has counseled clients through internal and government investigations and the resolution of overpayment issues through negotiated settlements. He works with hospitals, physician groups, labs, and other healthcare providers in a variety of transactions, such as mergers, acquisitions and joint ventures. Mr. Domsten’s practice includes representing entities in the regulatory aspects of healthcare transactions, including corporate structuring, diligence, licensure, reimbursement, and credentialing. Additionally, he works with many not-for-profit healthcare organizations to ensure their governance and operations comply with legal requirements as well as best practices and for tax-exempt hospitals, he provides assistance regarding IRS and state law requirements governing financial assistance and community benefit activities.

Ms. Minnick provides legal and strategic advice to payors, providers, and risk-bearing entities as they navigate the complexities of state and federal managed care and value-based payment laws while minimizing regulatory risk and maximizing business opportunities. She draws on years of focused experience in the managed care and value-based payment space to counsel managed care organizations, clinically integrated networks (CINs), accountable care organizations (ACOs), independent physician associations, and other health care entities on a wide range of regulatory matters. Clients value Ms. Minnick’s practical, business-oriented legal guidance, which helps them structure and operationalize compliant arrangements in a rapidly evolving health care landscape. She regularly drafts, reviews, and negotiates complex provider participation agreements with health plans as well as value-based arrangements between payors, providers, and risk-bearing entities. With a deep understanding of both the regulatory environment and business dynamics of managed care, Ms. Minnick partners with clients to align compliance with competitive positioning. Beyond her managed care and value-based payment practice, she is passionate about public health issues, including vaccine access, HIV prevention, contraceptives, and women’s health.

Mr. Parikh works with managed care organizations, hospital systems, life sciences companies, and other healthcare providers, delivering legal counsel on a wide range of regulatory, reimbursement, and transactional matters. With extensive experience in corporate boardrooms, courtrooms, and before administrative agencies across the United States, he guides public and private organizations on a variety of business arrangements involving health plans, physicians, behavioral health providers, hospitals, hospices, nursing facilities, long-term care facilities, and drug and device manufacturers. Mr. Parikh’s practice encompasses federal and California fraud and abuse compliance, licenses and permits, Medicare and Medicaid (Medi-Cal) participation and reimbursement, False Claims Act internal and government investigations, and enforcement actions. He also counsels clients on legal issues related to health information technology, bioethics, AI, privacy, security compliance, digital health, and telemedicine matters.

Health care providers, payers, digital health companies, and investors call on Ms. Worthen for legal and strategic advice as they navigate complex regulatory and business challenges in the continuously evolving health care delivery and reimbursement landscape. Her practical guidance enables clients across the health care ecosystem—health systems, hospitals, physician practices, digital health companies, behavioral health providers, third-party administrators, health plans, and investors—to implement both short- and long-term strategies that align with their organizational goals. Ms. Worthen possesses a wealth of experience working on matters concerning Medicare reimbursement, Medicare Advantage, participation in CMS Innovation Center payment models, managed Medicaid, managed care contract negotiations, and value-based payment arrangements with commercial payers, self-insured employers, and Medicare Advantage plans. She provides counsel on the regulatory, operational, and financial considerations necessary for maneuvering through the changing payment environment, including various forms of risk-based payment models, price transparency, revenue cycle and payment integrity, clinically integrated network development and value-based enterprise models, risk adjustment, and provider compensation arrangements. Beyond her health care practice, Ms. Worthen provides ERISA counsel to employers regarding their defined benefit and defined contribution retirement plans, as well as self-insured and fully insured welfare benefits plans, and has represented clients in government audits conducted by the IRS and the U.S. Department of Labor.