Practice Areas & Industries: Patton Boggs LLP

Practice/Industry Group Overview

The Health Care Practice at Patton Boggs is recognized as one of the preeminent health policy practices in the nation. As leaders in this complex area, our professionals use their knowledge of federal, state, and local health care issues to counsel clients on legal and policy matters under federal administrative and regulatory rules, with a particular focus on health care policy initiatives. We advise large corporations, major trade associations and national, state, and local governments and organizations, including insurers, employers, physicians and providers, hospitals, pharmaceutical companies, device manufacturers, biotechnology companies, nonprofit organizations, and municipal interests before both the Congress and federal agencies.

Most of the lawyers in our health group have served in high-ranking positions in administrative agencies and on congressional committees, developing a deep understanding of the inner workings of health care regulatory systems and of the development of health care policy on Capitol Hill. They are able to provide our clients with an inside edge to confront the myriad challenges facing the health care industry, whether through regulatory and legislative counseling, corporate and transactions advice, or litigation services. For example, if a proposed regulation threatens the competitiveness of a client's business, we will meet with relevant agency representatives to request modifications that will minimize the burden. Alternatively (or concurrently), we also may seek to persuade Members of Congress to adopt legislative language that accomplishes this goal. Should these efforts fail, our litigators are ready to assist clients to challenge agency rulings in the federal courts.

Representative Matters:

Secured a correction notice from the Centers for Medicare and Medicaid Services (CMS) to remedy errors in the CY 2006 Physician Fee Schedule for the dialysis community, thus avoiding a significant cut in Medicare reimbursement.

Persuaded CMS to adopt current industry best practices as the standard of care for pharmacy services provided to Medicare beneficiaries under the new prescription drug benefit program.

Successfully advocated the adoption of broad CMS requirements for coverage of mental health medications by plans participating in the Medicare prescription drug benefit program.

Secured $1 million in fiscal year 2005 appropriations for an Institute of Medicine study regarding the delivery of psychosocial care to cancer patients and their families.

Persuaded CMS to treat Puerto Rico as a separate region for Medicare Prescription Drug Plans and local Medicare Advantage plans, thus ensuring beneficiaries' access to coverage and avoiding premium increases.

Obtained enactment of $1 billion increase in Medicare reimbursement for dialysis services as part of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA).

Secured inclusion in the MMA of provisions to address the specialized pharmacy needs of Medicare beneficiaries residing in long-term care facilities.

Persuaded the U.S. Court of Appeals for the Third Circuit that the dismissal before trial of a false claims case was proper where it was alleged that a pharmacy accepted the return of unused prescription medication that had been paid for by Medicaid, did not credit Medicaid for the returned medication, and resold it to Medicaid. The court ruled that it was not sufficient for the whistleblower to show that medications were returned and recycled and that 60 percent of the pharmacy's business was with Medicaid¿the whistleblower was required to provide at least one example of a specific medication that was paid for by Medicaid, returned to the pharmacy, and then resold to another Medicaid beneficiary.

Successfully defended a major teaching hospital accused of billing Medicare for the services of teaching physicians when the services were actually performed by residents¿ the medical records failed to indicate that the teaching physician was present when the services were being performed This decision was affirmed by the U.S. Court of Appeals for the Eighth Circuit.

Ensured full access to the new Medicare Part D benefit and the Medicare drug discount card program and related subsidies for Medicare beneficiaries residing in Puerto Rico.

Advanced provisions enacted in the MMA to increase Medicare reimbursement for physicians and hospitals in the Commonwealth of Puerto Rico.

Obtained language restoring Medicare reimbursement levels for Skilled Nursing Facilities and Home Health in the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA).

Successfully advocated for positive regulatory guidance regarding the HIPAA Privacy Regulation to ensure the continuation of a supplier's business activities.

Developed HIPAA policies and procedures tailored to the unique needs of device suppliers reimbursed directly by Medicare.