The cost of care for chronic conditions consumes a significant portion of overall U.S. healthcare spending. With the prevalence of chronic disease in the United States rising, the future of U.S. healthcare depends on controlling these costs and ensuring quality along appropriate clinical pathways. Care- and disease-management companies play an increasingly important role in managing the disease-related “spend” of third-parties payors.
At Duane Morris, our healthcare attorneys are experienced advocates and counselors who understand every aspect of the climate in which care management and disease management service providers operate, from the business itself and managing payor relationships to the regulatory environment and the reimbursement process. We work closely with our clients to help them understand insurance regulation; comply with privacy and confidentiality rules; negotiate payor/provider arrangements; recognize whether professional practice, utilization review or third-party administrator rules and regulations might affect or restrict their business activities; and understand the implications of federal and state fraud and abuse prohibitions.
Additionally, Duane Morris healthcare attorneys have experience representing closely held businesses and private equity investors in care- and disease-management service providers.