Michael A. Dowell has extensive experience representing healthcare organizations on operational issues, regulatory compliance and transactional matters. His clients include hospitals and health systems, community health centers, federally qualified health centers, pharmacies, managed care plans, physician organizations, management companies, pharmacy benefit managers, ancillary service providers and a variety of other businesses in the healthcare industry.
Mr. Dowell has particular experience in the following areas:
- Federally Qualified Health Centers. He has significant experience counseling nonprofit health care organizations, including state licensed primary care clinics, community health centers, and federally qualified health centers. He assists community clinics and federally qualified health centers on matters including start-up, affiliations and joint ventures, governance, fiduciary duty and liability, conflicts of interest, for-profit conversions, mergers and acquisitions, lobbying and political activities, and grant management.
- Fraud and Abuse. Mr. Dowell regularly advises clients on structuring transactions and conducting day-to-day business operations to ensure compliance with the Anti-Kickback Statute, the Stark law, Medicare and Medicaid participation and billing requirements, professional licensing rules, and corporate practice of medicine and fee-splitting restrictions. He also has extensive experience in the development and implementation of corporate compliance programs; internal reviews and investigations; due diligence reviews for acquiring and acquired entities; voluntary disclosures; and federal and state governmental investigations arising from False Claims Act whistleblower actions.
- 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.
- Hospitals and Health Systems. Mr. Dowell has extensive experience representing nonprofit and for-profit hospitals and health systems in a wide variety of regulatory, operational and strategic business issues, including health care facility licensing, certification and accreditation; consent, medical records and bioethics; medical research and clinical trials; physician recruitment; hospital based physician contracts; health plan contract disputes; risk management; and compliance with applicable fraud and abuse laws.
- Managed Care Plan Licensure and Regulation. Mr. Dowell represents health insurers and other managed care organizations in complying with Medicaid managed care requirements, Medicare Part C and D rules, HIPAA portability and nondiscrimination mandates, and state licensing and regulatory requirements. He also has extensive experience drafting and negotiating the full range of managed care contracts, including provider participation agreements, as well as specialty carve-out and pharmacy benefit management arrangements.
- Pharmacy Law. Mr. Dowell counsels and represents pharmacists, pharmacy owners, pharmacy benefit management companies, managed care plans, and Medicare Part D Plans regarding fraud and abuse laws, licensure, pharmacy regulatory matters, contracts, acquisitions and sales, federal and state compliance issues, audits by third-party payers and matters before the Board of Pharmacy and Drug Enforcement Administration.
Some of Mr. Dowell’s representative transactions include:
Hospitals and Health Systems
Managed Care Plans and Insurers
- 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
Physician Organizations/Management Companies
- 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
Mergers and Acquisitions
- 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
Compliance Program Counseling and Defense
- 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
HIPAA Privacy and Security
- 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
- 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
Mr. Dowell is a prolific author. A selection of his publications includes:
- "The 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.
- “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:
- "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.