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December 11, 2015 at 12:38 PM
Two health care lawyers in Chicago say they are seeing the Patient Protection and Affordable Care Act (PPACA) shape a big new market for everyday compliance, deal-making and dispute resolution legal services.
Deborah Dorman-Rodriguez, the leader of the health care practice group at Freeborn & Peters LLP, Chicago, and David Kaufman, another partner in the group, said in an interview that they are now seeing plenty of activity somewhere on the PPACA audit spectrum, and that they are starting to get an idea of what future PPACA-related litigation might look like.
“There are a lot of audits,” Dorman-Rodriguez said.
Clients are also getting many requests for information, and they are involved with other types of pre-audit activities that could lead to formal enforcement action, she said.
See also: 3 ways PPACA 1095-C reporting may zap your clients
Dorman-Rodriguez previously was the chief legal officer at Health Care Service Corp. (HCSC), the company that runs the Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas. Kaufman has been general counsel to the New Mexico State Corporation and Commission, and the New Mexico superintendent of insurance.
The lawyers said that much of the audit, pre-audit and audit-like activity they are seeing involves matters such as the PPACA medical loss ratio (MLR) reporting program or compliance with PPACA benefits mandates.
Kaufman said the entities starting the proceedings include state insurance regulators, the U.S. Department of Labor, and the Center for Consumer Information and Insurance Oversight (CCIIO) – the arm of the Centers for Medicare & Medicaid Services (CMS) in charge of administering CMS-PPACA programs that affect the commercial health insurance market.
“It’s a very, very active space,” Dorman-Rodriguez said.
Until recently, many health care lawyers were rushing to help clients set up PPACA-related programs and procedures.
Some health care lawyers were still focusing on providing basic advice about how PPACA is supposed to work, and whether various provisions, such as the individual coverage mandate or the birth control benefits mandate, were really constitutional. Some reported seeing a somewhat surprising lack of litigation, or the kinds of activities that could lead up to litigation.
See also: PPACA World: Where’s the litigation?
Lawyers involved with PPACA compliance said they were seeing some letters from state or federal agencies asking various parties for information, but not a flood of audit and pre-audit activity.
Freeborn & Peters is also seeing plenty of legal work involving the creation of accountable care organizations (ACOs), helping health-related organizations consolidate, and helping providers get into taking insurance-like risk and insurers get into providing health care.
