Kate McDonald represents clients across the healthcare industry on complex regulatory matters and high-stakes mergers and acquisitions, affiliations and other investments. She delivers strategic advice on federal and state laws applicable to health insurers and HMOs, including the downstream implications for their provider organizations and vendors, as well as the reimbursement landscape of federal healthcare programs. Kate serves as partner-in-charge of McDermott’s healthcare practice in Washington, DC.
Kate’s clients rely on her extensive experience navigating the Medicare Advantage, Medicare Part D and Medicaid managed care programs. She partners with health plans, provider organizations, technology start-ups, private equity funds and retailers to benchmark risks, solve regulatory challenges and structure transactions, particularly those that involve federal and state healthcare programs. As payors and providers continue to realign in today’s market, Kate offers nuanced insights into the unique obstacles and opportunities facing companies at the intersection of these two worlds. She helps innovative companies navigate state risk-bearing regulations, drafts and negotiates agreements with complex reimbursement structures and regulatory implications, and advises healthcare companies and private equity funds on investments in highly regulated segments of the healthcare market.
Kate’s healthcare regulatory experience also includes deep insights into DC certificate of need (CON) laws. She helps providers obtain CON approval for the introduction and expansion of healthcare services, changes in ownership, capital expenditures, and closure of healthcare services or facilities in Washington, DC.
Kate is a contributing author to Regulation of Medicare Part D Plans (Thomson Reuters, 2019 edition) and Thomson Reuters Health Law Handbook (2017 edition). She speaks regularly at healthcare industry events, including the Wall Street Journal Health Forum, American Health Lawyers Association Institute for Health Plan Counsel, Blue Cross Blue Shield National Summit, Health Care Compliance Association Managed Care Compliance Conference, and Medicaid Managed Care Congress. Kate was the first recipient of the McDermott Will & Emery Client Service Award (2019).
Represented CVS Health Corp. in connection with its approximately $70 billion acquisition of Aetna Inc., leading a multidisciplinary team of McDermott lawyers advising on health regulatory, tax, real estate, intellectual property, IT and other matters
Provided corporate, health and tax representation for CVS Health Corp. in connection with the divestiture of Aetna Inc.’s standalone Medicare Part D prescription drug plans to a subsidiary of WellCare Health Plans, Inc.
Represented Medicare Advantage organizations and Part D plans in connection with successful administrative appeals of Quality Star Ratings and application denials
Counseled Part D plans and pharmacy benefit managers on related party arrangements, Any Willing Pharmacy rules and prescription drug pricing reform
Evaluated proposed business arrangements between health insurers, providers and pharmacies for potential risks under the federal Anti-Kickback Statute, Beneficiary Inducement Civil Money Penalties Law and False Claims Act
Provided strategic advice regarding demonstration programs sponsored by the Center for Medicare & Medicaid Innovation
Drafted and negotiated provider, vendor and pharmacy benefit management agreements for health plans
Led a multidisciplinary regulatory due diligence team in connection with a $400 million acquisition of an independent medical group
Performed health regulatory due diligence on a provider organization specializing in high-touch in-home care for chronically ill patients
Represented healthcare organizations, venture capital funds and private equity investors in connection with proposed investments in and acquisitions of health insurers and HMOs
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