Managed care is one of the most heavily regulated sectors of the health care industry, and every state has its own rules. Providers need sophisticated advisors who can respond quickly and adeptly to the complex and evolving legal, regulatory, and business issues inherent in working with managed care organizations (MCOs). Baker Donelson's attorneys have years of hands-on experience – both as in-house and outside counsel – serving as trusted advisors to for-profit and not-for-profit providers across the full spectrum of health care services.
With mounting pressure to slash costs, the aggressive techniques and strategies of the managed care sector – once confined to health maintenance organizations – have become ubiquitous. Baker Donelson provides strategic counsel to leaders in the health care industry as they navigate private and public payors' persistent efforts to reduce payment to providers.
We know the law. And we know the business of health care.
Litigation
Litigation against MCOs is on the rise nationwide, with payors using their market leverage to force providers into accepting pennies on the dollar for necessary, life-saving care. Baker Donelson's managed care litigation attorneys are at the forefront of the fight for providers against the nation's largest payors. Our in-depth knowledge of reimbursement practices, health care operations, contract negotiations, and the rigid billing practices of MCOs position our litigators to aggressively protect clients' interests in all manner of litigation involving managed care, from payor-provider disputes (both in- and out-of-network), to False Claims Act litigation, to class actions and Employee Retirement Income Security Act (ERISA) litigation.
Our extensive experience includes representation of:
- Hospital systems
- Provider networks
- Emergency service providers
- Long term care providers
- Home health providers
- Anesthesia providers
- Dialysis providers
- Telehealth providers
Contract Development and Negotiation
Negotiating contracts with MCOs presents complex issues of responsibility, liability, and risk, with overlapping federal and state laws and regulations to consider. Baker Donelson's attorneys have deep experience negotiating a wide range of agreements, from hospital system contracts, to contracts involving health plans and physician groups and alternative health care delivery organizations. As advisors to numerous regional and national health care providers, our objective is to help clients structure their agreements to effectively meet their business, operational, and compliance needs.