Our health care practice group works extensively with national and regional health insurers, HMOs, other managed care organizations, third party administrators, and self-insured plans on a wide range of regulatory and transactional matters and litigation. Our lawyers have significant experience in handling health care reimbursement and insurance issues and we advise our managed care and health insurance clients in all phases of licensing, approvals and regulatory compliance under federal and state law. Our lawyers provide managed care regulatory, compliance and operations advice to health plans, health insurers, TPAs and intermediaries, provider organizations and others that are offering, administering or participating in commercial health insurance products, Medicare Advantage plans or managed Medicaid plans. We advise and assist on managed care contract negotiations and on regulatory matters, including interacting on our clients’ behalf with regulators. Our lawyers have closely followed the enactment of the Affordable Care Act (ACA) and its implementing regulations and continue to advise our managed care and health insurance clients on ACA implementation and compliance as well as strategic opportunities created under ACA and health care’s evolving landscape. Our lawyers regularly assist our managed care and health insurance clients with structuring and closing mergers, acquisitions and divestitures as well as the development of strategic alliances and payor-provider joint ventures. Our experience includes:
Our representative projects include:
Our lawyers represent health plans and other managed care organizations with matters involving Medicare managed care. This history has involved client representation under the Medicare Risk program, the Medicare + Choice program and the Medicare Advantage program adopted by the Medicare Modernization Act. Our clients include large national health plans and smaller regional and local Medicare Advantage plans. Our experience includes the following:
Managed Care Contracting
Lawyers at Locke Lord represent managed care plans in developing and negotiating provider contracts with physicians, multi-specialty physician groups, IPAs, hospitals, ancillary providers and intermediaries. Our lawyers have developed health plan contracts with capitated providers that have served as models for the industry. Firm lawyers also represent IPAs and physician groups in developing contracts with their participating providers. Our experience includes:
Cigna Acquisition of QualCare. A multi-disciplined team of Locke Lord lawyers represented Cigna Corporation in its acquisition of New Jersey-based QualCare Alliance Networks, Inc.