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    Overview

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    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:

    • ERISA
    • Fraud and abuse
    • HIPAA and state law privacy and security matters
    • State HMO and insurance laws
    • Medicaid managed care
    • Medicare Advantage plans
    • Mental health parity
    • Peer review and credentialing
    • Affordable Care Act implementation and compliance
    • Specialty health plans (including behavioral health, vision, dental, chiropractic and acupuncture)
    • Discount programs
    • Disease management
    • Utilization review and medical bill review
    • Workers' compensation
    • Mergers, acquisitions and divestitures
    • Strategic alliances and joint ventures

    Our representative projects include:

    • Assisted various clients in developing and implementing compliance plans and strategic initiatives in response to federal health care reform.
    • Assisted national Medicaid managed care company develop commercial health plan products to be offered on the ACA public exchanges in eight states.
    • Represented numerous large and small health plans and insurers in obtaining regulatory approvals for changes of ownership.
    • Represented various health plans as deal counsel in the acquisition of target health plans or the sales of all or part of their businesses.
    • Represented health plan association in developing a plan agreeable to state regulators which allowed Medi-Cal managed care plans in California to receive additional state and federal funding.
    • Represented managed care plans in the negotiations of their agreements with PBMs.
    • Represented a large national health organization in reviewing and analyzing peer review laws for all 50 states; developed a comprehensive electronic report explaining the results of the review and analysis.
    • Represented workers' compensation carrier in review and analysis of managed care systems and policies, including utilization review, PPO networks and medical bill review.

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