Health Care and Life Sciences

Recent global events have upended the health care industry, resulting in unprecedented challenges as well as unexpected opportunities. In addition to increased government regulation and financial scrutiny, health care providers must navigate a sea of technological, operational, and strategic changes.

Lewis Roca provides cost-effective and comprehensive solutions to participants across the industry, leveraging our considerable experience in transactional, intellectual property, regulatory, and litigation law. We represent a wide range of health care clients – from hospitals to physician groups, long-term care facilities, biotechnology companies, managed care plans, and insurers – who rely on our counsel to succeed.

Our health care team is recognized by Chambers USA, which lauds our “substantial expertise in dispute resolution” and “significant experience representing clients in high-profile class actions and arbitrations.” We devote considerable time to industry participation – from speaking and publishing to keeping apprised of the latest trends – which enables us to offer clients concrete, up-to-the-minute advice.

Services

Corporate Health Care Transactions

We couple extensive transactional experience with exhaustive industry knowledge to aid clients during their most pivotal moments. Our team of seasoned dealmakers regularly collaborates with our deep bench of experienced health care practitioners to provide comprehensive counsel on a wide array of issues – including regulatory compliance and approvals, risk assessment, and pending legislative matters  – and structure deals that advance our clients’ goals. Whether steering clients through a merger, an acquisition, or forming a specialty physician group, we possess the acumen needed to get the deal done. Our services include:

• Business and employment taxes
• Business and staff agreements
• Corporate governance
• Debt and equity finance transaction
• Employee benefits and compensation structures
• Facility leasing and purchase
• Formation of multispecialty and single specialty physician groups
• Fraud and abuse and anti-kickback issues
• HIPAA privacy and security issues
• Joint ventures 
• Mergers and acquisitions
• Reorganizations
• Tax-exempt and foundation formation and compliance

Intellectual Property Protection

As participants in one of the world’s most technologically advanced industries, health care entities need lawyers who understand the art, science, and engineering of health care. The majority of our IP lawyers hold STEM degrees, which give us an edge in understanding the complex science behind our clients’ innovations. Our services include:

• Developing patent strategies
• Patent prosecution and management
• International patent protection
• Trademark portfolio management, prosecution, and defense
• Trade secrets protections
• IP litigation
• Licensing

Health Care Regulatory Counseling

Health care entities operate in a dynamic regulatory landscape. Changing state and federal regulations have a profound impact on health care organizations of all kinds, creating a pressing need for counsel that understands the legal principles behind government decisions. While this volatility has the potential to stifle an organization’s financial security, limit growth opportunities, or even threaten its future, our team has the knowledge, experience, and skill set to help clients chart a smooth course to success. Our services include:

• Affordable Care Act advisory services
• Compensation and payment issues
• Credentialing
• Disciplinary proceedings before boards and other regulatory agencies
• Government relations and lobbying
• HIPAA compliance
• Hospital and medical facility governance and compliance
• Informed consent procedures and documentation
• Investigations, hearings, and litigation

Health Care and ERISA Litigation

We represent industry-leading managed care plans, health insurers, self-funded employee benefit plans, and related entities in a wide array of health care litigation matters. Our team deploys a keen understanding of the industry to achieve successful results for clients on key issues at the forefront of the industry. Recognized as leaders in their field, our seasoned litigators have successfully represented clients in court, arbitration, mediation, and administrative proceedings, and have served as counsel of record in numerous precedent-setting decisions. Our services include:

• Counsel on HIPAA, data breach, and privacy violations
• Defending out-of-network provider litigation
• ERISA and Medicare benefits litigation
• Handling antitrust and class action litigation
• Leading False Claims Act investigations and litigation
• Litigating restrictive covenant and trade secret matters
• Managed care litigation, including payor-provider reimbursement disputes, breach of contract, and overpayment recovery
• Managing Mental Health Parity and Addiction Equity Act claims

Our Experience

• Health Care Facility Operator. Retained to defend two separate arbitration matters filed by a for-profit operator of health care facilities against our client, a global health care company with 36,000 employees, in Colorado, Ohio, and Kansas/Missouri. In each action, the facilities operator packaged a number of claims alleging the improper denial of coverage for services provided to its patients into an arbitral forum seeking to avoid application of the standard of review, discovery limitations, and procedures applicable to employer-sponsored, ERISA-governed plans. The matters were favorably settled.
• Health Care Plan Company. Retained to defend the largest health care company in the world – with $226 billion in annual revenue and 115 million customers – and its affiliates in the defense of a lawsuit brought by several emergency physician groups seeking a higher level of reimbursement for emergency services provided to our client’s members. The emergency physician groups are out-of-network providers and therefore have no agreement with our client that sets their rates. Contending that they are entitled to the prevailing usual and customary rates citing to Arizona law, the providers allege violations of Arizona statutes, including violation of Arizona’s racketeering statute A.R.S. § 13-2314.04 in setting reimbursement. We successfully removed the case to federal court and moved to dismiss the claims based on ERISA pre-emption, which was granted by the district court.
• Nonprofit Health System. Represented a nonprofit health system, the borrower, as special counsel in three series of taxable bond financings totaling $1.2 billion. We conducted customary diligence, negotiated the financing documents, and prepared opinions to the underwriters and trustees. The bonds were issued by the Maricopa County Industrial Development Authority (Arizona) and are secured by a pledge of general revenues. This financing allows our client to construct new hospitals in Tucson and Phoenix, Arizona.
• Rehabilitation Hospital Staff. Retained by the medical staff at Hawaii's only acute-care rehabilitation hospital to provide advice in the investigation and, ultimately, suspension of clinical staff privileges of a high-profile physician due to improper sexual conduct in the workplace. We directed the internal investigation and advised the medical staff throughout the process by advising on proper notice to the physician as well as the physician’s due process rights and hearing rights while protecting the medical staff’s immunity under the Health Care Quality Improvement Act. We also advised on reporting requirements to the National Data Bank and state agencies in Hawaii. During the process, the affected physician filed a lawsuit in the federal district court in Hawaii to enjoin the suspension of the staff privileges. We defended the medical staff and, after a hearing, the district court issued its order denying the physician’s request for an injunction.
• Health Care System. Assisting one of the leading not-for-profit health care systems in the United States with strategic acquisitions. We structured the transactions to close our client’s acquisition of a Wyoming-based medical center: the state’s largest hospital with 249 beds; more than 45 medical specialties; and 13 primary, specialty, and immediate care clinics. As the only full-service, nonprofit hospital with comprehensive heart, stroke, and trauma care in the area, it serves 11 Wyoming counties numbering more than 250,000 people.
• Medical Finance Company. Retained to counsel a financing company that facilitates medical treatment of injury victims by offering upfront financing for doctors in return for medical provider liens on tort recovery damages handled by lawyers who pursue the parties legally responsible for injury or their insurers. Recent work for our client and its affiliates involves advice on medical lien financing practices and laws and continuing negotiation of the loan by which the purchases of medical receivables are financed, including the exploration of alternative participating and nonparticipating lenders of receivables subject to various concentration limits and the formation of additional special purpose vehicles for this purpose. We also worked on amendments to the primary financing agreement to permit the formation of a separate special purpose entity for a certain category of receivables that the primary lender agreed could be financed by a specialty lender based on heavily negotiated conditions. These negotiations included resolution of certain risks relating to the priority of liens on receivables. We have begun to assist on a complete takeout of the primary lender, with planning as necessary to preserve continuing perfection about assignment of existing receivables.
• Medical Nonprofit Organization. Helped an organ procurement organization plan for and later work with providers and policymakers to win the passage of the Uniform Anatomical Gift Act. Also worked with organ procurement organizations as they started planning to implement the law.