As the healthcare industry continues to find pathways that shift certain services from fee-for-service to value-based reimbursement models, providers, payors, and other stakeholders must adapt to a rapidly evolving environment. Frier Levitt’s Value-Based Care attorneys regularly assist client’s structure, implement, and defend innovative value-based payment and care-delivery arrangements that seek to align financial incentives with quality, better patient outcomes, and cost efficiency, while maintaining compliance with federal and state laws.
Comprehensive Counsel for Value-Based Care Models
Our multidisciplinary team successfully combines extensive healthcare regulatory experience with practical business insight. Frier Levitt advises clients at every stage of the value-based care continuum – from entity formation and preliminary contracting to ongoing compliance evaluation, and instances of dispute resolution and/or litigation.
Frier Levitt assists clients navigating:
- Shared-savings and risk-bearing arrangements
- Bundled and episode of care payment models
- Gainsharing and global capitation structures
- Development of Value-Based Enterprises (VBEs)
Structuring Value-Based Enterprises (VBEs)
In 2022, the U.S. Department of Health and Human Services’ (DHHS) introduced the “Regulatory Sprint to Coordinated Care” Final Rules which allows healthcare stakeholders to enter compliant, collaborative value-based arrangements.
Our attorneys guide clients through the design and implementation of VBEs that:
- Operate around clear Value-Based Purposes, such as improving quality, coordinating care, and reducing costs
- Establish appropriate governance and accountability structures
- Document Value-Based Activities and compensation arrangements satisfying Stark and Anti-Kickback Statute requirements
- Develop detailed policies, procedures, and oversight mechanisms to ensure compliance and audit readiness
We draft and review organizational documents, such as operating agreements, bylaws, compensation agreements and structures, and participation policies to ensure our clients’ models maintain regulatory compliance while simultaneously supporting operational efficiency and financial performance.
Building Value-Driven Healthcare Organizations
Frier Levitt has extensive experience of forming and advising value-based organizations, including:
- Accountable Care Organizations (ACOs)
- Independent Physician Associations (IPAs)
- Clinically Integrated Networks (CINs)
- Organized Delivery Systems (ODSs)
Our attorneys guide clients through the governance, operational, and compliance challenges of building and maintaining these value-based entities, as well as evaluating compliance with federal and state antitrust, fraud-and-abuse, and provider-incentive-plan rules and regulations.
Negotiating and Enforcing Value-Based Care Contracts
Because value-based care contracts often lack transparency around payor data and reimbursement methodology, Frier Levitt leverages its transaction and litigation experience to protect provider interests.
We assist clients by:
- Negotiating fair and transparent shared-savings, bundled-payment, and risk-based agreements
- Securing audit rights and robust dispute-resolution provisions
- Advising providers in direct negotiations with employers and plan sponsors, as well as assisting such organizations’ administrative service providers develop compliant and practical relationships.
- Resolving payment disputes through pre-litigation negotiation or litigation against commercial carriers, Medicare Advantage Organizations, and Managed Medicaid Plans
Our goal is to ensure that every value-based contract promotes accountability, aligns with regulatory frameworks, and protects provider revenue.
Ensuring Compliance and Mitigating Risk
Compliance is central to every successful value-based care model. Frier Levitt’s attorneys develop customized compliance frameworks designed to meet the complex requirements of federal and state regulators.
Our services include:
- Drafting and advising on compliant shared-savings and incentive agreements
- Creating VBE compliance worksheets and monitoring tools tailored to organizational needs
- Advising on fraud, waste, and abuse (“FWA”) considerations, AKS/Stark compliance, and risk-adjustment documentation
- Advising on Provider Incentive Plan regulations, including required stop-loss protections for “substantial financial risk” arrangements
Through proactive compliance, our clients are better able to navigate and avoid common pitfalls that invite regulatory scrutiny while also enhancing the integrity of their value-based operations.
Defending Providers in Investigations and Litigation
When disputes or enforcement actions arise, Frier Levitt provides its clients with experienced, strategic defense strategies. We represent providers, health systems, and executives in civil and criminal proceedings related to value-based care arrangements, including:
- Alleged False Claims Act or risk-adjustment upcoding violations
- Civil Monetary Penalties Law actions tied to shared-savings programs
- Breach-of-contract claims by payors, health plans, or managed-care entities
Our attorneys have successfully defended clients in high-stakes government and payor investigations, helping protect clients’ financial and professional interests.
Who We Represent?
Frier Levitt represents a wide spectrum of stakeholders participating in or supporting value-based care, including:
- Hospitals and health systems
- Independent and hospital-based medical practices
- Self-funded health plans and employer-sponsored groups
- Administrative service providers, such as conveners
- Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), and Independent Physician Associations (IPAs)
- Private Equity-backed provider platforms
- Provider-aligned vendors, data analytics, and technology firms
- Pharmaceutical and medical-device manufacturers engaging in value-based contracting
Why Frier Levitt
For over two decades, Frier Levitt has been at the forefront of healthcare and life sciences law. Our Value-Based Care team offers:
- Regulatory depth—unmatched understanding of AKS, Stark, and emerging federal and state value-based care related rules and regulations
- Strategic insight—guidance grounded in extensive experience navigating provider and payor dynamics
- Proven advocacy—experience negotiating, enforcing, and litigating complex value-based agreements
How Frier Levitt Can Help
If your organization is exploring or is currently participating in value-based arrangements or facing challenges with compliance, payor disputes, or enforcement actions, our experienced attorneys can help you structure compliant agreements that mitigate risk and achieve success in this evolving healthcare landscape.
Frier Levitt provides strategic, industry-focused legal counsel tailored to your needs. Contact our team today to learn how we can help you.
