Mr. Dowell practices in the areas of healthcare, regulatory and corporate law. With more than 30 years of experience, he represents clients in a variety of sectors within the healthcare industry, including federally qualified health centers, health plans, PPOs, HMOs, Medicaid Managed Care Plans, Medicare Advantage Plans, PACE Programs, employer self-insured plans, pharmacy benefit managers, pharmaceutical manufacturers, retail pharmacies, long-term care pharmacies, specialty pharmacies, compounding pharmacies, mail order pharmacies, wholesale drug distributors, hospitals, health systems, long-term care providers, physician organizations, management companies, and ancillary service providers.
Mr. Dowell counsels clients in a variety of corporate and contractual transactions, including mergers and acquisitions, joint ventures, affiliations, licensing, financing and services-related transactions. He also advises clients in federal and state fraud and abuse matters, compliance program development, governmental audits and investigations, Medicare, Medicaid, HIPAA and data privacy, meaningful use of electronic medical records, licensing, health care reform delivery models (including ACOs, value-based payments, and pay-for-performance), concierge medicine, and managed care law.
Mr. Dowell has published several articles and spoken at conferences regarding various health law issues, including compliance, fraud and abuse, pharmacy law, federally qualified health centers, HIPAA privacy and security, and managed care contracting and payment disputes.
Mr. Dowell has particular experience in the following areas:
Federally Qualified Health Centers
Mr. Dowell has significant experience counseling nonprofit health care organizations, including state licensed primary care clinics, community health centers, and federally qualified health centers, on a broad range of legal matters. He provides guidance on start-ups, affiliations and joint ventures, governance, 340B drug discount programs, conflicts of interest, mergers and acquisitions, compliance programs, lobbying and political activities, and grant management.
Mr. Dowell counsels and represents pharmacies (including chain, independent, long-term care, specialty, compounding, nuclear, veterinary, and prison) in all 50 states, and pharmacists, pharmaceutical manufacturers, wholesalers, pharmacy benefit management companies, Medicare Part D Plans, drug wholesalers, drug and dietary supplement manufacturers, and retail medical oxygen dealers. Mr. Dowell has counseled such clients regarding licensure, pharmacy regulatory matters, contracts, acquisitions and sales, federal and state laws and regulations governing pharmacy and controlled substances, third party payer audits, matters before State Boards of Pharmacy and Drug Enforcement Administration, and HIPAA privacy and security compliance.
Managed Care Plan Licensure and Regulation
Mr. Dowell provides health insurers and other managed care organizations regulatory advice concerning compliance with various state and federal health care and state managed care plan and insurance laws and regulations, including Medicare Advantage, Medicaid Managed Care, PACE programs, the Affordable Care Act and other health reform initiatives, and obtain help them obtain regulatory approvals from federal and state agencies, including the Centers for Medicare and Medicaid Services, and The California Department of Managed Health Care, Department of Insurance, and Department of Health Care Services. He represents clients in related federal and state agency enforcement matters and transactional matters, including mergers and acquisitions and joint ventures between managed care plans, insurers and providers.
Mr. Dowell counsels individual physicians, medical groups, independent practice associations (IPAs), management services organizations (MSOs), physician practice management companies, accountable care organizations, and other physician organizations, on organizational, operational and regulatory matters, mergers and acquisitions, joint ventures, affiliations, managed care contracting, third party reimbursement, hospital-physician contracting, federal and state fraud and abuse and self-referral laws, Medicare and Medicaid audits and other federal and state compliance issues.
HIPAA Privacy and Security
He has substantial experience in counseling health care industry clients on all aspects of information privacy and security issues, including state laws and the HIPAA Privacy and Security rules. Mr. Dowell conducts risk assessments, drafts privacy policies and advises on the development of other privacy safeguards. He helps clients respond to complaints and privacy breaches. He also helps clients negotiate the full range of health care technology contracts, including general software licenses, electronic medical records agreements, and data use agreements.
Mr. Dowell joined Hinshaw & Culbertson LLP in December 2009. Previously he was a co-chair of the Health Care Industry Group at Theodora Oringher Miller & Richman PC in Los Angeles.
Mr. Dowell began his legal career in 1983 as a staff attorney with the National Health Law Program in both Washington, D.C. and Los Angeles. In 1989, he became corporate counsel to CIGNA Healthcare of California. From 1991 to 2006, he was Chair of the Health Care Practice Group at Miller & Holguin in Los Angeles.
- California Society for Healthcare Attorneys, Education Committee, Appointed Member
- American Bar Association, Health Law Section
- State Bar of California, Business Law Section
- Los Angeles County Bar Association, Health Law Section, Past Chair
- American Health Lawyers Association
- American Society for Pharmacy Law
Honors & Awards
- Named annually since 2005 to the Super Lawyer list published in Southern California Super Lawyer magazine and Los Angeles magazine
Some of Mr. Dowell’s representative transactions include:
Hospitals and Health Systems
- Drafted and negotiated medical director and hospital-based physician coverage agreements for radiology, emergency medicine, anesthesiology and pathology
- Counseled numerous hospitals on all aspects of licensure, certification and accreditation, including Medicare and Medicaid enrollment, change of ownership, and operational issues
Managed Care Plans and Insurers
- Development and formation of Medicare Advantage Plans, Medicaid HMOs, commercial plans, and specialized health plans (vision, dental, chiropractic and mental health)
- Drafting, negotiating, and analyzing fee-for-service and capitation physician organization and managed care plan contracts and related documents
Physician Organizations/Management Companies
- Representation of physicians and medical groups, including IPAs, in the review, analysis and negotiation of all types of managed care plan agreements, including multi-year payor agreements
- Development of physician and dental practice management services agreements to conform to corporate practice of medicine, fee splitting, and anti-kickback laws
Mergers and Acquisitions
- Structured, negotiated and documented a $80 million sale of a management company and affiliated professional medical corporations located in multiple states to a large, publicly traded company and its affiliated professional medical corporations
- Conducted health care regulatory due diligence and general corporate representation of client in its acquisition of a four-hospital Health System
Compliance Program Counseling and Defense
- Developed and implemented a Corporate Compliance Plan, code of conduct, and policies and procedures for a nonprofit integrated delivery system comprised of an HMO, physician organization, federally qualified health clinic, and community health programs
- Conducted an internal investigation for a Medicare and Medicaid HMO to determine compliance with Medicare marketing requirements
HIPAA Privacy and Security
- Counseled hospitals and health systems, health plans, insurers, governmental entities, physician organizations and personal health record vendors with respect to a wide range of privacy and security compliance issues
Mr. Dowell also speaks regularly to many organizations, including the American Association of Health Plans, American Health Lawyers Association, California Association of Dental Plans, California Association of Health Plans, California Black Health Network, National Black Prosecutors Association, National Dental Association, National Health Law Program, National Health Lawyers Association, State Bar of California and the Health Care Law Section of the Los Angeles County Bar Association. His presentations include:
- "Mid-Level Practitioners: A Primer on the Legal Issues Affecting a Growing Segment of the Health Care Delivery Workforce," Orange County Bar Association
Health Care Law Section Meeting, Newport Beach, California, September 2014.
- "Fraud & Abuse," California Society for Healthcare Attorneys Annual Meeting & Spring Seminar, Olympic Valley, California, April 2014.
- "EHR, PHI, HIPAA, HITECH: Deciphering the Alphabet Soup for Data Privacy and Security in Health Care Delivery," 88th Annual Convention & Exhibits, National Bar Association, Miami, Florida, July 2013.
- "The Omnibus Rule and Its Impact on HIPAA Compliance," National Bar Association Health Law Section Webinar Series, June 2013.
- "A Map to Healthcare Reform Compliance," Minority Corporate Counsel Association's 12th Annual CLE Expo, San Diego, California, March 2013.
- “HIPAA Security Breaches and Cyber- Liability,” Hinshaw’s Annual Health Care Conference, Lisle, Illinois, November 2012.
- “Defending Against False Claims Actions and Identifying the Other Fraud & Abuse Implications of Managed Care Litigation,” American Conference Institute’s 2nd Advanced Forum on Management Care Disputes and Litigation, Phoenix, Arizona, November 2011.
- “Basics of Health Plan Law,” California Society of Healthcare Attorneys 2011 Fall Seminar & Back to Basics, Los Angeles, California, November 2011.
- “Effective Collaboration Between Hospitals and Federally Qualified Health Centers/Rural Health Centers,” National Association of Health Services Executives 26th Annual Education Conference, Henderson, Nevada, October 2011.
- “Managed Care Contracting After Health Care Reform,” Hinshaw’s 2010 Health Care Conference, Lisle, Illinois, November 2010.
- “Healthcare Fraud and Abuse in a Tougher Enforcement Environment,” Strafford Publications, Inc., live webinar, April 2010.
- “Recent Healthcare Fraud Enforcement Efforts Under the Obama Administration and Impact to Plans, Payors and Providers,” American Health Lawyers Association, live webinar, February 2010.
Mr. Dowell is a prolific author. A selection of his publications includes:
- "Recent OCR Enforcement Actions Emphasize the Importance of Executing HIPAA Business Associate Agreements," BNA's Health Law Reporter, June 2016.
- "Federally Qualified Health Center Federal Tort Claims Act Insurance Coverage," co-author, The Health Lawyer, February 2015.
- "HIPAA Settlement With Community Pharmacy Highlights Best Practices For the Handling and Disposal of Paper PHI," BNA’s Health Law Reporter, May 21, 2015.
- "Federally Qualified Health Center and Look-Alike Sliding Fee Discount and Related Billing and Collections Program Requirements," co-author, Journal of Health Care Compliance, January/February 2015.
- "Federally Qualified Health Center and Look-Alike Bureau of Primary Health Care Operational Site Visit Compliance Audits," co-author, Journal of Health Care Compliance, July/August 2014.
- "Executive Summary: New Health Center Governance Requirements," co-author, American Health Lawyers Association Practice Group Executive Summary, April 2014.
- "Hospital-Physician Transaction Compliance Strategies to Address Recent Fraud and Abuse Enforcement Actions," Journal of Health Care Compliance, March/April 2014.
- "The Case for Federal Oversight of EHR Vendors to Promote Interoperability and Usability," co-author, Electronic Health Reporter, February 10, 2014.
- "Sharing of Secure Patient Information Requires Strong Breach and Notification Policies," co-author, Electronic Health Reporter, January 15, 2014.
- "Risk Management Concerns Arising Out of HITECH and the Hospital Re-admission Penalties Program," co-author, Electronic Health Reporter, November 14, 2013.
- "Commentary: the case for extending MU Stage 2," co-author, Government Health IT, August 30, 2013.
- "Healthcare Risk Management Challenges Created by Federal Regulation of Electronic Medical Records and Care Management," Journal of Healthcare Risk Management, July 16, 2013.
- "Commentary: Concerns About Quality Improvement Organizations Actions Around Meaningful Use," co-author, Government Health IT, June 25, 2013.
- "Commentary: Delving Into HIPAA Breach Notification," co-author, Government Health IT, May 1, 2013.
- "Commentary: The Litigation and Risk-Management Concerns Meaningful Use Triggers," co-author,Government Health IT, March 29, 2013.
- “Meaningful Use Electronic Health Record Incentive Payment Audits: Are You Ready,” BNA’s Health Law Reporter, November 29, 2012.
- “Medical Spas Now Subject to New California Regulatory Requirements,” Los Angeles Daily Journal and San Francisco Daily Journal, August 31, 2012.
- “2013 Medicare Marketing Guidelines Present New Compliance Challenges,” BNA’s Medicare Report, July 13, 2012.
- “HIPAA Compliance Audits and Heightened Enforcement Are Coming: Are You Ready?” BNA’s Health Law Reporter, August 30, 2011.
- “The OIG’s Hospital Compliance Initiative,” BNA’s Health Care Fraud Report, August 10, 2011.
- “Compliance Program Implications of Recent HIPAA Privacy Enforcement Activities,” BNA Health Law Reporter, Vol. 20, No. 11, March 17, 2011.
- “HRSA Issues New Section 340B Guidance for Contract Pharmacy Services,” CCH Health Care Compliance Letter, Commerce Clearing House, Volume 13, Issue 8, April 20, 2010.
- “Outsourcing: A Cost-Effective Way to Achieve Health Care Compliance,” Journal of Health Care Compliance, March-April 2010.
- “President Obama Targets Healthcare Fraud: Payors, Plans and Providers Beware!” Payors Plans & Managed Care, a publication of the American Health Lawyers Association, Volume 12, Issue 3, December 2009.
- "HHS and FTC Release Guidance on HITECH Act Requirements," Journal of Health Care Compliance, July–August 2009
- "Federal Funding and Regulation of Health Care Information Technology and Electronic Health Records under the HITECH Act," CCH Health Care Compliance Letter, June 2009.
- "Revised Anti-Markup Rule Will Have Significant Impact on Physician Diagnostic Testing Service, Billing Arrangements," BNA Medicare Report 19, No. 14, April 2008.
- "New Safe Harbor Protects Certain Financial Arrangements Involving Federally Qualified Health Centers," CCH Health Care Compliance Letter 10, no. 24, December 2007.
- "Beware of the Office of Inspector General: OIG 2007 Work Plan Challenges and Solutions for Medical Groups," Group Practice Journal 56, No. 1, January 2007.
- "Update Your Compliance Plan Now: The OIG's 2006 Work Plan Targets May Impact You!" Journal of Health Care Compliance 8, No. 2, March–April 2006.
- "Phase II of the Final Stark II Regulations: Practical Implications for Medical Groups," Group Practice Journal 53, No. 8, September 2004.
- "Phase II of The Final Stark II Regulations: Implications for Medical Groups." California Association of Physician Groups Update 6, No. 8, August 2004.
- "Fraud and Abuse Issues in Forming and Operating Hospital-Physician Joint Ventures" and "Factors to Consider When Selecting a Joint Venture Organizational Structure," Journal of Health Care Compliance 4, No. 6, November– December 2002.
- "Developing Mechanisms for Reporting Compliance Violations," co-author, Healthcare Financial Management 55, No. 8, August 2001.
- "The Importance of Being Earnest: Assessing the Effectiveness of a Health Plan's Compliance Program," co-author, Healthplan 42, March–April 2001.
- "OIG Urges Review of Physician Office Space Rental Arrangements," co-author, Group Practice Journal 49, No. 6, June 2000.
- July 10, 2014
- March 10, 2014"Hospital-Physician Transaction Compliance Strategies to Address Recent Fraud and Abuse Enforcement Actions"
- November 14, 2013
- October 22, 2013
- October 13, 2013Hospitals & Health Networks Magazine
- November 29, 2012
- September 5, 2012
- July 13, 2012
- August 26, 2016Health Law Alert
- Pharmacies and Prescription Drug Dispensers...Are You Ready for The March 1, 2016 DSCSA Compliance Deadline?February 23, 2016Health Law Alert
- August 25, 2015Health Law Alert
- June 4, 2014Health Law Alert
- April 14, 2014Health Law Alert
- Stark Law Violations Stemming from Improper Incentive Compensation Paid to Employed Physicians Result in $85 Million SettlementApril 7, 2014Health Law Alert
- August 21, 2013
- July 3, 2013Health Law Alert
- April 2, 2013Health Law Alert
- February 11, 2013Health Law Alert
- February 1, 2013Health Law Alert
- January 24, 2013Health Law Alert
- August 23, 2012Health Law Alert
- April 11, 2012Health Law Alert
- January 23, 2012Health Law Alert
- October 26, 2011Health Law Alert
- New Business Opportunity for Health Care Providers: The Medicare Bundled Payments for Care Improvement InitiativeSeptember 27, 2011Health Law Alert
- May 19, 2011Health Law Alert
- May 11, 2011Health Law Alert
- May 5, 2011Health Law Alert
- Business & Commercial Transactions
- Health Care Fraud & Abuse, Compliance and Regulatory Requirements
- Health Care Information Technology, Privacy and Security
- Health Care Law
- Health Care Provider Operations
- Health Care Transactions
- Life, Health, Disability & ERISA Litigation
- Managed Care Payment, Contracting and Regulatory Matters
- Mergers & Acquisitions
J.D., Indiana University Maurer School of Law
B.S., Pharmacy, Purdue University
- District of Columbia