Managed Care Contracting

 

Wolfe Pincavage healthcare attorneys provide sophisticated legal counsel to a broad range of healthcare providers including hospitals, physician groups, provider staffing organizations, specialty physician associations, medical device companies, pharmacies, laboratories, healthcare billing companies, and healthcare technology companies.   Wolfe Pincavage provides clients with innovative legal advice with regards to managed care contracting, managed care dispute resolution, healthcare transactions, and healthcare regulatory and compliance.

Managed Care Counseling and Contracting

The attorneys at Wolfe Pincavage are experienced at negotiating and drafting contracts between healthcare providers and commercial, governmental, and international payors and networks.  With years of experience in resolving healthcare payment disputes, we know what managed care contract provisions must be included to limit exposure to risk, maximize clients’ bottom line, and decrease administrative burden.  We provide clients with creative strategies to optimize managed care relationships and business operations. We also assist clients to develop policies that streamline contract negotiation with payors. 

We understand the ever-changing health insurance industry and its unique regulatory requirements and provide up-to-date advice on a wide-range of topics including value-based contracting, prompt pay laws, utilization review and audits, third-party vendor issues, and underpayments.  

Managed Care Dispute Resolution

Our attorneys implement creative solutions to resolve our clients’ disputes.  We deliver results in a cost-effective manner and efficiently utilize all available tools to achieve the best possible outcomes for our clients.  We have achieved favorable outcomes for our clients through dispute resolution mechanisms and successfully resolved a myriad of payment and operational disputes without resorting to litigation.  

Healthcare Transactions

The healthcare attorneys at Wolfe Pincavage are experienced with the regulatory, corporate, finance, and antitrust considerations intrinsic to healthcare transactions.  Our healthcare attorneys have a unique understanding of the healthcare industry’s rapidly changing business, legal, and regulatory environment. This is increasingly important as the industry moves towards performance-based payment models and market consolidation. 

We leverage this knowledge to assist clients with implementation of creative strategies that minimize risk; maximize value for patients, providers, and investors; and maintain compliance with various state and federal laws and regulations. We actively help clients develop and manage beneficial partnerships within their healthcare communities to establish joint ventures, group and super group practices, management services organizations, and independent practice associations.

Wolfe Pincavage healthcare attorneys provide clients with the necessary skills to negotiate favorable transactional documents. We advise clients on all elements of health industry transactions, including guidance through due diligence, evaluation of existing contractual arrangements, and on-going analysis of risks, opportunities, and potential regulatory issues.

Healthcare Regulatory and Compliance

Wolfe Pincavage provides clients with innovative and strategic legal advice concerning corporate governance, labor and employment of providers and other medical staff, professional services, and compliance with state and federal regulatory issues. Our experience covers areas including HIPAA and the HITECH Act, Affordable Care Act, fraud and abuse, self-referral, anti-kickback, False Claims Act, and the Sunshine Act.  We also provide sophisticated counseling to assist organizations obtain necessary certification and licensing from state and federal agencies.