Lawyers / Professionals

 
R. Brent Rawlings       
Associate
One James Center
901 East Cary Street
Richmond, Virginia 23219-4030
T: 804.775.1126
F: 804.698.2252
rbrawlings@mcguirewoods.com
 

Mr. Rawlings concentrates in healthcare law, including state and federal regulatory compliance; Medicare, Medicaid and private payor regulation and payment appeals, reimbursement and billing, fraud and abuse compliance; healthcare contracts; joint ventures; merger, acquisition, affiliation, and changes of ownership of healthcare providers; managed care contracting and operations; provider networks (IPAs, PHOs) and antitrust; and certificate of public need.

His practice includes representation of hospitals and health systems, academic medical centers, physician groups, ancillary providers, long-term care facilities and senior care communities, and managed care plans.

In addition to his legal training and experience, he holds a master's degree in health administration, is board certified in healthcare management, and has previous experience in the healthcare industry.


Practices & Industries
Honors
  • Named a Virginia Super Lawyers "Rising Star," 2009-2011
  • Named One of 12 "Outstanding Young Health Care Lawyers," Nightingale's Healthcare News, 2008
  • Fellow, American College of Healthcare Executives

Previous Experience
  • Associate, Hancock, Daniel, Johnson & Nagle, P.C., Richmond, Virginia
  • Network Consultant, Trigon Blue Cross Blue Shield, Richmond, Virginia
  • Senior Contract Specialist, UnitedHealthcare of Illinois, Chicago, Illinois
  • Supervisor, Provider Contract Management, Wellmark HealthNetwork, Oak Brook, Illinois

Publications
  • "Industry Comments Show Some Consensus in Provider Opposition to Key Components of CMS's Proposal for the Medicare Shared Savings Program," ABA Health eSource, ACO Special Edition, August 2011
  • "At the Crossroads: Accountable Care Organizations and Antitrust Law," Health Care Law Monthly, Volume 2011, No. 5, May 2011
  • "Agencies Issue Antitrust Guidance for Medicare ACOs," ABA Health eSource, ACO Special Edition, April 2011
  • "Accountable Care Organizations (ACOs) and the Shared Savings Program: Some Common Misconceptions and Unanswered Questions," BNA's Health Insurance Report, Volume 16, No. 42, October 2010
  • "Long Term Care Reform: Federal and State Initiatives Focus on Home and Community-Based Services to Promote 'Aging in Place' for Medicaid," LTC Advisor (Publication of the American Health Lawyers Association), Volume 13, Issue 2, July 2010
  • "To Bundle or Not To Bundle: Lawmakers Explore the Question," (Co-authored with Jason Greis and J. Brian Jackson), LTC Advisor (Publication of the American Health Lawyers Association), Volume 12, Issue 3, August 2009
  • "CMS and 'Never Events': An Overview of Recent Changes to Medicare Payment and Coverage Policies," The RAP Sheet (Publication of the American Health Lawyers Association Regulation, Accreditation, and Payment Practice Group), Volume 12, Issue 1, March 2009
  • Medicare Recovery Audit Contractors (RACs): What Providers Need to Know and How to Prepare, December 2008
  • "Medicare Claims and Activity Recovery Audit Contractors: A Look at Process, Plans for Expansion, and Lessons from the Demonstration States," The RAP Sheet (Publication of the American Health Lawyers Association Regulation, Accreditation, and Payment Practice Group), Volume 10, Issue 4, November 2007
  • "The Effect of Hospital Charges on Outlier Payments under Medicare's Inpatient Prospective Payment System: Prudent Financial Management or Illegal Conduct?" (Co-authored with Hugh E. Aaron), Annals of Health Law, Volume 14, Issue 2, Summer 2005
  • "The Challenge of EMTALA Compliance in Psychiatric Cases," (Co-authored with Mary C. Malone), Rx for Risk, Volume 11, Issue 4, Fall 2003
  • "Who Lost Cost Containment? A Roster for Recrimination," (Co-authored with Robert E. Hurley), Managed Care Quarterly, Volume 9, Issue 4, Fall 2001

Speaking Engagements
  • "Stark Law 101," National Organization of Rheumatology Managers Annual Conference, September 17, 2011
  • Moderator, "ACOs and Managed Care Contracting," McGuireWoods 9th Annual Business & Legal Issues in Dialysis & Nephrology Symposium, May 12, 2011
  • "Accountable Care Organizations," Central Virginia Healthcare Executive Group (Chapter of the American College of Healthcare Executives), April 20, 2011
  • "Senior Care, Health Reform and the Strategic Planning Imperative," McGuireWoods Post-Acute & Senior Care Conference, October 8, 2010
  • "Virtual CCRCs, Home Based Assisted Care, Resident Ownership of ILUs and Other Successful Options in Today's Senior Care Market," McGuireWoods Post-Acute & Senior Care Conference, September 10, 2009
  • "Physician Integration Strategies," Central Virginia Healthcare Executive Group (Chapter of the American College of Healthcare Executives), August 19, 2009
  • "Healthcare Fraud and Abuse and Criminal Matters," Virginia Commonwealth University, Department of Health Administration, February 5, 2009
  • "Managed Care Contracting and Payor Issues for the Dialysis Industry," 7th Annual McGuireWoods Business & Legal Issues in Dialysis & Nephrology Symposium, May 13, 2009
  • "Responding to RAC Determinations: Overpayments and Medicare Appeals," Virginia Hospital & Healthcare Association and Medical Society of Virginia, CMS Recovery Audit Contractor Program: Are You a Target?, March 6 and 10, 2009
  • "Preparing for an RAC Audit," McGuireWoods Teleconference, March 2009
  • "Trends in Provider and Payor Relations," Carolinas Health Care Forum, November 2008
  • "Healthcare Fraud and Abuse in the Physician Practice Setting," Virginia Commonwealth University, Department of Health Administration, October 2008
  • "Trends in Provider and Payor Relations," McGuireWoods Teleconference, April 2008
  • "Medicare Drug Benefits: How Does Part D Fit In?" Virginia Hospital & Healthcare Association, Medicare Part D - Ready or Not Here it Comes . . ., November 2005
  • "Outlier Payments under Medicare's Hospital Inpatient and Outpatient Prospective Payment System: What Financial Managers Need to Know," Virginia Healthcare Financial Management Association, Winter Meeting, February 2005

Professional Affiliations
  • American College of Healthcare Executives
    • Recipient, ACHE Service Award, 2010
    • Regent's Advisory Council, 2008
  • American Health Lawyers Association
  • Virginia State Bar, Health Law Section
    • Board of Governors, 2010-2012
  • American Bar Association, Health Law Section

Civic Affiliations
  • Central Virginia Healthcare Executive Group
    • President, 2008
    • Vice President, 2007
    • Board Member, 2006-Present
  • Richmond Area High Blood Pressure Center
    • Secretary, 2007-Present
    • Board Member, 2005-Present
 

EDUCATION

University of Richmond, T.C. Williams School of Law, Richmond, Virginia, J.D., cum laude, 2004

Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, M.H.A., with Honors, 2004

The Pennsylvania State University, University Park, Pennsylvania, B.S., Health Policy Administration, 1995

 
 

ADMITTED

Virginia 2004

District of Columbia 2005

 

PLACE OF BIRTH

Owensboro, Kentucky