Representative Experience

• Advised national health insurer in connection with its acquisition of Medicare Advantage products across multiple markets from a competing national health insurer, including regulatory and reimbursement considerations tied to the transition of risk-bearing business and integration of provider enablement operations.
• Acted as regulatory and value-based care counsel for health insurer and private investor in strategic acquisition involving ACO business and affiliated provider network, including reimbursement diligence, payor contracting analysis, and evaluation of potential exposure related to risk adjustment risks.
• Counsel to regional health system in connection with the negotiation and formation of a joint venture risk-bearing entity with a regional health insurance payor, including structuring governance, reimbursement, and risk-sharing arrangements for a value-based care platform.
• Counsel on provider group acquisition of REACH ACO platform, including the structuring of delayed closing for CMS approval.
• Counsel to national provider network on provider network design, rental network strategy, and risk-bearing funding activities, including development of reimbursement contracting structures with the client’s actuarial team, servicing direct-to-employer products.
• Counsel to de novo multi-specialty physician platform on the structuring of a “super” practice model, enabling specialty physician groups to retain autonomy over local operations while participating in an integrated platform, including governance, physician alignment, and ancillary services structuring.
• Counsel to community care hub on the development of provider-adjacent support services in collaboration with local provider partners, including structuring service offerings and negotiating payor arrangements to be delivered through the hub and its network participants.
• Counsel to a public home care and hospice provider across several acquisitions in multiple markets, acting as regulatory specialist supporting multi-state licensing, payor enrollment, and payor contracting to support post-closing operations and avoid revenue leakage.
• Counsel to hospital system in significant hospital acquisition arising from bankruptcy proceedings, including leading diligence efforts and drafting key interim management and transition services agreements.
• Counsel to General Vision Services on sale of risk-bearing vision network and managed care platform in connection with its sale to NationsBenefits, including advising on all components of the transaction and navigating complex labor-related issues and underfunded benefit plans associated with the target’s network operations.
• Counsel to HeartPlace, P.A., the largest physician-ownedphysician owned cardiology practice in Texas, in connection with its recapitalization by US Heart & Vascular, an Ares Capital company.
• Advised medical oncology and hematology practice in connection with a long-term affiliation with a health system, including negotiation of an anchor-tenant arrangement in a new cancer center and related real estate and operational arrangements, enabling the practice to maintain independence while expanding strategic alignment with the health system.
• Counsel to Orthopaedic Institute of Dayton in its recapitalization by Orthopaedic Associates and Revelstoke Capital Partners, LLC.
• Acted as lead counsel in the sale of Medical Imaging Services, LLC to 626 Imaging, a Peak Rock Capital portfolio company.
• Advised University of Florida and UF Health Corporation in the acquisition of the Florida operations of The Scripps Research Institute.
• Counsel to a middle-market private equity sponsor in (i) the recapitalization of a Medicaid-reimbursed non-medical home health agency and (ii) the development of a de novo pediatric telemedicine platform.
• Advised a large primary care physician group on a partial recapitalization by a private equity investor and the establishment of a risk-bearing entity structure, including strategies to retain physician control while developing alternative revenue streams tied to payor contracting.*
• Assisted ACOs and CINs on governance, financial arrangements, membership, and managed care payor contracting with risk adjustment and shared savings models.
• Advised providers and non-providers participating in the Medicare Shared Savings Program and other CMMI models on governance, reimbursement, and shared savings disputes, including appeals of benchmark adjustments affecting payment determinations.*
• Advised national insurers, PBMs, and provider-affiliated health plans on Medicare Advantage and Part D compliance, payor disputes, Medicaid managed care procurements, and provider contracting strategy.
• Advised an insurtech platform on health insurance operations, provider network development, and population health tools to support risk-bearing models.*

*Matters handled prior to joining Foley.