Michael Dowell is a health care law attorney who counsels hospitals, health plans, physician organizations, ancillary service providers and other health care entities on regulatory, transactional and operational issues.

He advises clients on physician organization and medical group development and operations, management services organization compliance with applicable laws, the development and implementation of health care compliance programs, hospital and health system licensure, certification and operational matters, and HIPAA Privacy and Security compliance.

Mr. Dowell has significant expertise in managed care plan licensure, contracting and regulatory compliance matters, and the regulation and operation of Medicaid Managed Care Plans, Medicare Advantage Plans and Discount Health Plans.

He counsels health care entities on structuring contracts, joint ventures, mergers, acquisitions and other business arrangements to comply with the anti-kickback and Stark fraud and abuse laws, corporate practice of medicine and fee-splitting prohibitions, as well as other regulatory requirements. He defends clients subject to state or federal anti-kickback, false claims, or whistleblower allegations, and provides advice and counsel regarding internal investigations, governmental investigations and voluntary disclosures.

In addition, Mr. Dowell represents numerous non-profit health care organizations, including affiliations and joint ventures, in matters involving governance, fiduciary duty and liability, conflicts of interest, for-profit conversions, mergers and acquisitions, lobbying and political activities, and grant management. He works closely with non-profit hospitals, federally qualified health centers, look-alikes, and other licensed community clinics.

Prior to practicing law, Mr. Dowell graduated from one of the top Pharmacy Schools in the United States, and worked as a licensed pharmacist at both retail and hospital pharmacies. Today, he counsels and represents pharmacists, pharmacy owners, pharmacy benefit management companies, managed care plans, and Medicare Part D Plans regarding licensure, pharmacy regulatory matters, contracts, acquisitions and sales, federal and state compliance issues, audits by third-party payers, matters before the Board of Pharmacy and Drug Enforcement Administration, and HIPAA privacy and security compliance. 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 4-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 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.

Mr. Dowell is an appointed member of the Education Committee for the California Society for Healthcare Attorneys. His professional memberships also include the American Bar Association (Health Law Section), the State Bar of California (Business Law Section) and the Los Angeles County Bar Association, where he is a past chair of the Health Law Section. In addition, he belongs to the American Health Lawyers Association and the American Society for Pharmacy Law.

He has been named annually since 2005 to the Super Lawyer list published in Southern California Super Lawyer magazine and Los Angeles magazine. Mr. Dowell is a prolific author. A selection of his publications includes:

• “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.
• “Co-Management Re-emerges as a Hospital-Physician Integration Option,” HASC Briefs Focus, December 10, 2010.
• “New Federal Sentencing Guidelines requirements for an effective compliance program,” HCCA Compliance Today, Volume 12, Number 9, September 2010.
• “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.

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:

• “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.