Managed Care Organizations

Ober|Kaler's Health Law Group has broad experience in managed care contracting involving hospital and health systems, physician groups, clinical laboratories and pharmacies. Our experience includes assisting clients in the Mid-Atlantic states, the South and the West in reviewing contracts with government as well as all major private third-party payors. When requested, we have also represented the client in payor negotiations.

Our attorneys work closely with physicians to develop IPAs, and with hospitals and physicians to develop and merge PHOs. We have also advised clients on how to structure downstream arrangements to fit within the managed care safe harbors and the parallel exceptions under the Stark Law.

We assist clients in exiting from contracting organizations and from contracts that no longer serve their interests, including representation in arbitration and settlement proceedings. Our experience also includes representing health maintenance organizations and preferred provider organizations in the development process through organizational planning, the development of contractual documents. In one noted representation, Ober|Kaler provided the legal assistance required to sell – and later liquidate – a provider-sponsored health maintenance organization.

When our clients want to voice their concerns on regulatory issues at the federal and state government levels, we help ensure they are heard. We also help draft legislation to address statutory and regulatory barriers to fair contracting. Several members of the firm have served as special counsel to the Office of Health Maintenance Organizations of the Maryland Department of Health and Mental Hygiene.