Polsinelli added veteran healthcare lawyer Muthuramanan “Ramana” Rameswaran as a shareholder late last month in its Dallas office as part of the firm’s ongoing national expansion of the practice area.
Rameswaran advises healthcare organizations, investors and provider platforms on regulatory and transactional matters, physician groups, hospitals, health systems and private equity-backed organizations on M&A, joint ventures and complex organizational structures.
Before joining Polsinelli, Rameswaran was at Katten, where he served as a healthcare and corporate associate in the firm’s Washington, D.C., office before joining the Dallas office in the same capacity as a partner in August 2022. Prior to that, he was with Arent Fox and at Fox Rothschild for a few years as an associate. He is a graduate of Temple University’s law school.
The Texas Lawbook caught up with Rameswaran about his move to Polsinelli, the trends he’s seeing and more:
The Lawbook: What was the connection with Polsinelli that initially led to discussions about you joining the team and how did it start?
Rameswaran: Polsinelli has one of the deepest benches in healthcare that I have ever seen within a law firm. In addition to having known several people at the firm within the industry, I had always had a deep respect for the firm. But when my close friend made the switch from our old firm to Polsinelli a little more than a year ago, I really began to see why my friend made the switch and what opportunities it provides for our clients and, frankly, for us to grow as attorneys.
The Lawbook: What are two or three of the most important trends that you are seeing in your practice area?
Rameswaran: The biggest trend, in my opinion, has been the level of scrutiny that exists on healthcare consolidation, whether by mergers and acquisitions or otherwise, at both the federal and, more importantly, state levels. State legislators and regulators are taking a close look at transactions that in the past would [never] have even been on their radar. As advisors and counsel, it becomes acutely important to understand the intricacies of your client, but understand the industry at a holistic level so that we can help ensure stakeholders can achieve their goals. One of the other most important trends has been the change in how hospitals, providers, and manufacturers are addressing 340B issues. While the laws and regulations haven’t changed very often, the guidance and parameters under which stakeholders function seem to be changing monthly, if not weekly. It’s an area that I have been.
The Lawbook: What are two or three concerns or issues you are hearing most often from your clients?
Rameswaran: Some of the issues that I hear most often from healthcare providers generally surround issues with payors and systemic concerns with unwarranted prior authorization requirements, retroactive denials, and changes to coverage of services or drugs without a meaningful chance to hear from healthcare-provider stakeholders. Each of these items takes up a provider’s time and resources to resolve and can have direct effects on patients’ ability to obtain or access the care they need. One of the other concerns I hear most often is around “not knowing what you don’t know” from a compliance perspective. Providers of all types have to worry about changes in policies or laws and may not have the infrastructure to keep abreast of those changes. They may also not know about requirements that have existed for years because they have never been challenged on the issue. Once challenged, especially for a federal governmental payor where the lookback period is 6 years, the result of a minor mistake could be catastrophic.
The Lawbook: What has been your best day as a dealmaker?
Rameswaran: I love being part of a team where both sides are looking to do the right thing by our clients and get to the result they all want. One of my favorite parts of deals has been when I get to work internally or externally to resolve regulatory issues like disclosures related to the federal Stark Law or Anti-Kickback Statute. There have been many times that having an open dialogue has meant proactively identifying issues and filing the required disclosures. Because of the number of times I’ve filed certain disclosures, it is great to be a resource internally or for the other side to get to the right result quickly for both of our clients, especially where the disclosures are otherwise complicated.
The Lawbook: How is AI impacting your practice and how you work with clients?
Rameswaran: When used responsibly, AI has been a game changer. There are significant efficiencies which end up reducing costs to clients, especially in the context of due diligence reviews on transactions; but it is also a great tool to summarize new issues or identify areas you want to study more within a 2000+ page proposed rule. The key has been ensuring that we, as attorneys, still put our hands on everything, as I’ve personally found mistakes coming out of conclusions generated by AI.
The Lawbook: What are two or three of the most important achievements (transactions, successes, etc.) that you have scored for clients?
Rameswaran: Not many healthcare lawyers have had the opportunity to work with Hollywood studios, but during the pandemic, I was able to help ensure that the studios were able to compliantly provide COVID-19 testing to all of the on-site actors, directors, and crew members to film both movies and TV shows at locations around the world. Within the past year, I had the opportunity to serve as one of the key regulatory counsel on several blockbuster specialty physician-management service organization transactions with relatively complex structuring concerns and regulatory disclosures.
The Lawbook: Are there specific pro bono efforts or public service projects that mean the most to you?
Rameswaran: I have served and continue to serve in a variety of leadership positions within several groups within the American Bar Association, including the Health Law Section, the Young Lawyer Division, and the Council for Diversity in the Educational Pipeline. In the upcoming bar year, I am pleased to serve as a liaison to the Standing Committee on the Law Library of Congress. My favorite parts about the roles I’ve taken are always to be a resource to those that are just learning the profession and to help establish policy that can actually make a difference.