Wiley Rein LLP


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.

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