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Final Episode | Markets Under Pressure Strategies for Restructuring and Risk Management

By McDermott Will & Emery on Aug 11, 2022
Posted In Uncategorized

In this new video series, McDermott’s digital health team shares timely insights and strategies to help your organization stay ahead of the curve, addressing critical areas of workforce management, financing and the potential for restructuring.

Today’s market pressures increase the potential for broken financial covenants. In this episode, McDermott partners Dale Van Demark and Felicia Perlman discuss steps that digital health companies can take now to prepare for the possibility of restructuring and mitigate associated risks.

Explore the full series and their takeaways here.

Episode Two | Managing Capitalization Structures and Investor Relationships in Today’s Digital Health Market

By McDermott Will & Emery on Aug 11, 2022
Posted In Uncategorized

In episode two, McDermott partner and digital practice co-head Lisa Mazur joins fellow partner Brian Gordon to review important considerations for navigating today’s market realities.

Explore the full series and their takeaways here.

Episode One | Workforce Management Solutions in an Uncertain Economic Environment

By McDermott Will & Emery on Aug 11, 2022
Posted In Uncategorized

In episode one, Stephen Bernstein talks with McDermott partner Ellen Bronchetti about timely employment considerations for digital health companies.

Explore the full series and their takeaways here.

Navigating Volatile Markets in the Digital Health Ecosystem | Introduction – What to Consider

By McDermott Will & Emery on Aug 11, 2022
Posted In Uncategorized

Watch the introduction where Stephen Bernstein, Co-Head of the Digital Health Practice, kicks off the series discussing what companies should be considering as they navigate today’s complex digital health ecosystem.

Explore the full series and their takeaways here.

McDermott Earns “Elite” Firm Designation and 12th Consecutive Band 1 National Ranking from Chambers USA

By McDermott Will & Emery on Jun 3, 2021
Posted In Uncategorized

International law firm McDermott Will & Emery is pleased to announce its Healthcare Group received its 12th consecutive national Band 1 ranking in the 2021 edition of Chambers USA. The team also earned Band 1 state-level healthcare rankings in California, Florida, Illinois, Massachusetts and Washington, DC. Additionally, the Firm earned the national Spotlight Table ranking for the Privacy and Data Security: Healthcare category. Overall, the Firm saw a 25% increase in the number of new partners recognized, bringing the total to 37.

Chambers praised McDermott’s Health Industry Advisory practice, describing the team as “top-notch” and “very knowledgeable, responsive and practical.” Interviewees also drew attention to the Firm’s “incredible roster of clients.”

Clients provided similarly impressive remarks, noting our team’s deep bench strength and specialties. “McDermott is the best – they have the deepest knowledge and the most subspecialists” and “the firm consistently produces high-value work. It does a great job quickly analyzing and reporting out on regulatory and legislative changes.” One interviewee recognized “McDermott’s healthcare practice is unparalleled. It has experts on every corner of the industry.”

This year was particularly important and challenging for the health industry. Our passion and dedication to help clients achieve and surpass their business goals, while delivering the highest level of care – no matter the state of the healthcare landscape – was most important to us. “We are honored that Chambers USA again recognized our unwavering commitment to clients,” said Eric Zimmerman, global lead of McDermott’s Health practice. “After the challenges over the last year, these accolades feel particularly gratifying, because they reflect that we successfully served our clients on the front lines of the COVID-19 response as they advanced their missions and kept their businesses moving forward.”

Of the 37 Chambers USA recommended healthcare lawyers, 12 were ranked in Band 1, including Bernadette Broccolo, Stephen W. Bernstein, Ira Coleman, Charles Buck, John M. Callahan, Gary Scott Davis, Christopher M. Jedrey, James F. Owens, Michael W. Peregrine, Kerrin Slattery, Jerry J. Sokol and Eric Zimmerman. Additional lawyers were recognized across eight states, including seven lawyers who were added to the rankings for the first time and six who advanced from the previous year.

McDermott Will & Emery is the nation’s leading health law firm. The Health Industry Advisory group is the only health practice to receive top national rankings from U.S. News – Best Lawyers “Best Law Firms,” Chambers USA, The Legal 500 US, and Law360. The practice was also recognized by Chambers as “Health Team of the Year” in 2010, 2013, 2017 and 2019. McDermott has also held the top spot in PitchBook’s League Tables as the most active firm for healthcare private equity since 2017.

Read the full details about the Firm’s rankings and editorial commentary.

ABOUT CHAMBERS USA

Chambers USA rankings and editorial commentary are based on independent research, and interviews with clients and other purchasers of legal services. Chambers & Partners is one of the premier directories for legal services and in a survey of 20,000 in-house counsel over half [...]

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Digital Health at Scale: The Payor Perspective

By Kate McDonald and Marshall E. Jackson, Jr. on Aug 20, 2020
Posted In Telehealth, Uncategorized

The COVID-19 pandemic has catalyzed efforts by health insurers to expand reimbursement for telehealth services and digital health tools, and develop and invest in their own digital health technology. Health insurers, who increasingly play a hybrid role of payor, innovator and provider, have a vested interest in helping consumers manage chronic diseases and engage in preventive care from home, both during the public health emergency and after.

Joined by leaders from Humana, Oscar, and Medorion, we discussed the role of health insurers in the evolving digital health market, reimbursement pathways for digital tools and innovative partnerships between technology companies and health insurers. Click here to listen to the webinar recording, and read on for highlights from the program.

PROGRAM INSIGHTS

COVID-19 has accelerated the integration of digital health into the traditional health insurance framework. Pre-COVID-19, health insurers were using digital health tools to help their members find providers, access care and manage health conditions. COVID-19 has hastened health plans’ efforts toward vertical integration of digital health technology. Health insurers at the forefront of this effort are focused on creating a consumer-centric, digitally enabled and fully integrated healthcare ecosystem to enhance the member experience, bend the cost curve and carve out an essential (and expanded) role for themselves in the future of healthcare. As consumer behavior continues to change as a result of COVID-19, health insurers will have to be responsive to the way their members are getting care and interacting with the healthcare system.
Health insurers are uniquely situated to leverage digital health technologies. Data-driven technology is only as good as the data behind it. Due to the critical role health insurers play in paying for healthcare services, they have insight into member patterns of care and utilization that can be used to target interventions, influence member decision-making and improve health. Investments in digital tools and analytics, as well as strategic partnerships with technology companies, will allow for increased leverage of this valuable data, improved integration of member health information and enhanced member engagement.
Interoperability with existing health IT systems is crucial to break down barriers to digital health implementation. Healthcare has been grappling with data interoperability challenges for decades. To scale and make the information from digital tools actionable as part of a larger care plan, digital health platforms must also be interoperable with existing health IT systems. Interoperability will also allow insurers to gather a more complete picture of a member’s longitudinal health data and enable them to better support member health.
Health insurers and their legal teams will need to remain nimble amidst the rapidly changing regulatory environment. Keeping up with changing regulations during the COVID-19 public health emergency while planning to scale up in terms of technology implementations is a delicate balance. Though federal, state and local agencies appreciate that digital health tools and telemedicine have much potential in terms of patient care, health insurance companies remain vigilant of privacy and security risks and continue to be constrained in their [...]

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CMS Takes a Preliminary Step to Make Certain COVID-19 Waivers Permanent

By Lisa Mazur on Aug 14, 2020
Posted In Telehealth, Uncategorized

On August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule to update its payment policies under the Medicare Physician Fee Schedule (PFS) for calendar year 2021. The proposed rule was issued in tandem with a presidential executive order, which directed the Secretary of the US Department of Health and Human Services (HHS) to propose regulations expanding telehealth services covered by Medicare. CMS stated that the proposed rule “is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better accessibility, quality, affordability, empowerment, and innovation.”

In response to the coronavirus (COVID-19) public health emergency (PHE), CMS has issued several temporary waivers and flexibilities that expand telehealth reimbursement under Medicare, Medicaid and the Children’s Health Insurance Program for the duration of the COVID-19 PHE. CMS issued these waivers under authorities granted pursuant to HHS’s public health declaration, as well as legislation passed in response to the pandemic. Many of these waivers have substantially altered the Medicare telehealth reimbursement landscape and, as we detailed in our prior On the Subject, many can be made permanent via regulatory action. The proposed rule represents the first official word that CMS will take such action to make certain of its waivers permanent. These policy changes have the potential to greatly increase the availability of telehealth to Medicare beneficiaries around the country.

CMS will accept comments, either electronically or by mail, on the proposed rule until 5 pm EDT on October 5, 2020.

Changes to Medicare Telehealth Services

CMS proposed to add several services, listed below, to its list of services that may be delivered via telehealth. Many of these were previously added on an interim final rule basis for the duration of the PHE. The proposed rule would keep them on the Medicare telehealth services list even after the PHE ends.

CMS also proposed a new method for adding or deleting services from the Medicare telehealth services list. Currently, CMS evaluates new services for inclusion based on two categories: Category 1 is for services that are similar to professional consultations, office visits and office psychiatry visits that are already on the Medicare telehealth services list, while Category 2 is for services that are not similar to those already on the list, but that would still be appropriate to include because the service is accurately described by the corresponding code when delivered via telehealth and providing the service via a telecommunications system results in clinical benefit for the patient. Because of the COVID-19 PHE, CMS has proposed to add a Category 3, which would include services that would be temporarily on the Medicare telehealth services list. CMS proposed this third category because, while CMS currently has the authority to waive or modify Medicare telehealth payment requirements during the PHE, that authority will expire once the PHE [...]

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More Than a Decade at the Top; McDermott Earns 11th Chambers USA Band 1 Healthcare Practice National Ranking

By McDermott Will & Emery on May 6, 2020
Posted In Uncategorized

We are pleased to announce that our Healthcare Group received a national Band 1 ranking for the eleventh year in a row in the 2020 edition of Chambers USA. After more than a decade at the top, we are once again the only one to rank Band 1 nationally. The Health team also earned Band 1 state-level rankings for its healthcare practices in California, Florida, Illinois, Massachusetts and Washington, DC. Additionally, the team also earned the national Spotlight Table ranking for the Privacy and Data Security: Healthcare category. In addition, nearly half of the Healthcare Industry Advisory group partners were individually ranked.

Click here to view the full announcement.

McDermott Named “Healthcare Team of the Year” by Chambers USA

By McDermott Will & Emery on Jun 24, 2019
Posted In Uncategorized

International law firm McDermott Will & Emery was named 2019 “Healthcare Team of the Year” by Chambers USA at its awards ceremony celebrating legal excellence. This is the fourth time McDermott has received the honor – more than any other law firm in the awards’ history.

The “Healthcare Team of the Year” award comes on the heels of McDermott’s industry-leading health practice garnering a national Band 1 ranking in the Healthcare category of the 2019 edition of Chambers USA for the 10th consecutive year – also the only firm to hold that distinction.

“Our team is dedicated to helping health care companies push the boundaries of what it means to be innovative,” said McDermott Will & Emery Partner and International Head of McDermott’s Health Industry Advisory Group, Eric Zimmerman. “Receiving Chambers’“Healthcare Team of the Year” award is a powerful testament to that work and to our passion for contributing to the health care and the legal industries at the highest levels. Thank you to our clients and to Chambers for recognizing McDermott again this year.”

McDermott Will & Emery is the nation’s leading healthcare law firm. The Health Industry Advisory group is the only health practice to receive top national rankings from U.S. News – Best Lawyers “Best Law Firms,” Chambers USA, The Legal 500 US and Law360. The practice was also recognized by Chambers as “Health Team of the Year” in 2010, 2013 and 2017. McDermott has held the top spot in PitchBook’s League Tables as the most active firm for healthcare private equity since 2017.

About Chambers USA

Chambers USA covers all the states in the U.S. Law firms that have a national presence are also ranked in Nationwide tables (which focus on those firms that are the country’s best in their respective areas of practice). Chambers USA rankings and editorial commentary are based on independent research, and interviews with clients and other purchasers of legal services. Chambers & Partners is one of the premier directories for legal services and in a recent survey of 20,000 in-house counsel over half reported that their directory of choice when reviewing law firms and individual lawyers is Chambers & Partners.

Health Care Enforcement Roundup: Increased FCA Enforcement Against EHR Companies

By Amandeep S. Sidhu, James A. Cannatti III and Theodore Alexander on May 9, 2019
Posted In Uncategorized

The federal government has offered substantial incentives to providers to adopt and use certified electronic health record (EHR) technology. As of October 2018, the federal government had paid over $38 billion in EHR incentive payments through the Promoting Interoperability Program (formerly, the Meaningful Use Program). Other federal health care program policies also encourage use of certified EHR technology through enhanced payments or avoidance of decreased reimbursement. These EHR-related payment policies, however, have triggered increased oversight and enforcement attention on EHR vendors who have allegedly misrepresented the capabilities of their EHR software and allegedly paid kickbacks to customers.

In 2017, DOJ announced a settlement with eClinicalWorks (eCW), an EHR vendor, to resolve an FCA lawsuit originally brought as a qui tam action by a whistleblower. DOJ’s complaint-in-intervention alleged that eCW made material false statements and concealed material facts about the capabilities of its software in connection with the government’s EHR certification process.[1] It also alleged that eCW paid purported kickbacks in connection with certain marketing arrangements (i.e., a referral program, site visit program, and a reference program) with influential customers to induce them to recommend eCW’s EHR software, in violation of the federal Anti-Kickback Statute (AKS).[2]

As part of the settlement, eCW agreed to pay $155 million and to enter into a novel, five-year Corporate Integrity Agreement (CIA) with the HHS OIG. Among other things, the CIA required eCW to engage an independent Software Quality Oversight Organization to assess eCW’s software quality control systems and to regularly report to OIG and eCW on its reviews and recommendations. Further, the CIA required eCW to offer free upgrades and data transfers to its current customers. This was a ground-breaking settlement that raised the question of whether this was the beginning of government and whistleblower attention on (and FCA actions against) EHR vendors. This question was seemingly answered in the affirmative when DOJ announced a second settlement with an EHR vendor in early 2019.

On February 6, 2019, EHR vendor Greenway Health LLC (Greenway) entered into a similar settlement to resolve an FCA case filed by the US Attorney’s Office in Vermont. Interestingly, a whistleblower did not initiate the Greenway case. Rather, DOJ pursued it directly. Like eCW, Greenway faced allegations that its EHR system did not function in the way it represented it during the certification process.[3] One specific allegation was that Greenway provided some customers whose EHR software was improperly calculating certain meaningful use measures (which providers are required to achieve to be eligible for incentive payments) with incorrect calculations in order to enable them to receive incentive payments.[4] According to DOJ, this allegedly caused some Greenway customers to submit false claims to HHS for payment under the Promoting Interoperability Program.

Like in the eCW case, the government complaint against Greenway also alleged that certain payments from Greenway to its customers pursuant to certain reference, referral, and site visit programs [...]

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