Our lawyers advise health care entities on a broad range of government contract issues that arise in connection with their participation in federal and state health care programs. These engagements have included procurement, regulatory counseling, and compliance matters under Medicare, the Federal Employees Health Benefits Act, the U.S. Department of Defense (DOD) TRICARE program, and Medicaid. Wiley Rein attorneys regularly counsel clients competing for Medicare Administrative Contractors (MAC) contracts in the Federal Acquisition Regulation (FAR)-based environment mandated by Medicare contracting reform under the Medicare Prescription Drug Improvement and Modernization Act of 2003. We also advise clients bidding on Health Insurance Exchange (HIX) contracts and Medicaid Management Information Systems (MMIS) contracts under state procurement laws.
In conjunction with our colleagues in our Health Care Practice, we handle a full spectrum of matters relating to the procurement and provision of health care services under government contracts, including the analysis of government solicitations; the negotiation and drafting of contract terms with government agencies, subcontractors, network providers, and pharmacy benefit managers; the protest and defense of contract awards; counseling on contract administration issues and the prosecution of claims; and advising clients on matters of regulatory compliance (addressing issues of organizational conflicts of interest (OCIs), compliance with the Cost Accounting Standards (CAS) and FAR cost principles, mandatory and voluntary self-disclosures, kickbacks, data rights and uses, and subcontractor overpayments). We also represent health care companies in federal agency audits and related litigation, government investigations, and False Claims Act (FCA) litigation.
A growing segment of our practice is now devoted to advising clients on the application of health care reform legislation to their businesses and customers. We also are involved extensively in privacy and security matters for our clients, focusing on the continuing challenges associated with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification regulations and challenges under the Health Information Technology for Economic and Clinical Health Act (the HITECH Act), as incorporated in the American Recovery and Reinvestment Act of 2009.
Representative engagements include:
- Representing successful and unsuccessful bidders in MAC Recovery Audit Contractor (RAC) and TRICARE protests before the U.S. Government Accountability Office (GAO) and the Court of Federal Claims (COFC).
- Counseling a TRICARE contractor on legal issues related to the TRICARE T3 Managed Care Support request for proposal (RFP) and representing same contractor in protests before both the GAO and the COFC.
- Advising clients on OCI issues generally and, more recently, on the OCI implications of potential health care reform initiatives and innovations.
- Assisting MACs with the implementation of changes to their disclosed accounting practices and settling the cost impacts of those changes with the Government.
- Advising clients on intellectual property matters, including preventing the Government from obtaining rights to IP-related to cost-reimbursable contracts.
- Preparing requests for equitable adjustments (REAs) under MAC and TRICARE contracts and advising on the conversion of REAs to certified claims.
- Negotiating prime contracts with state HIXs.
- Negotiating subcontracts for MACs, TRICARE, and Medicaid contractors and Medicare Advantage plans.
- Negotiating multi-billion-dollar pharmacy benefit management contracts on behalf of Federal Employees Health Benefits (FEHB) and Medicare Advantage plans.
- Successfully defending TRICARE and Medicare contractors in FCA litigation.
- Drafting contingency plan administrative services subcontracts.
ISSUE: SPRING 2014
IN THIS ISSUE
- It’s My Appeal, But It’s Your Claim: ASBCA Orders Government to File Complaint in Appeal of Government Claim
- “Willfully” Reinterpreted: The Effect of DOJ’s Latest Interpretation of False Statement Statutes on Contractors’ Mandatory Disclosure Obligations
- Don’t Be Fooled by Fakes: Five Issues to Address in Complying with DOD’s New Counterfeit Electronic Parts Rule
- Are You Ready for Your CPSR?—Seven Areas for Focus
- Is Your Company SCA Compliant? Figure It Out Before the United States Department of Labor Figures It Out for You!
- GAO Agrees With ISDC: Many Agencies Have Enhanced Their Suspension and Debarment Programs and Increased the Use of Suspension and Debarment Remedies
- Wiley Rein Attorneys Partner with Lawline for “Federal Contracting: A Five-Part Series”
- Speeches & Publications
Six Steps to Prevent Disclosure of Internal Investigation Reports
By William A. Roberts, III, Mark B. Sweet and Richard B. O'Keeffe, Jr.
March 20, 2014
Risk Allocation in State Health Care IT Contracting under the ACA
By Daniel P. Graham and Nooree Lee
Winter 2014 | Public Contract Law Journal Vol. 43, No. 2
D.C. District Court Affirms OFCCP’s Expanding Jurisdiction Over the Health Care Industry
By Todd A. Bromberg, Jillian Volkmar and Christen M. Price
April 9, 2013