Managed Care Regulatory, Compliance & Operations

Our attorneys provide managed care regulatory, compliance and operations advice to managed care organizations. Several of our attorneys also have significant government agency experience. We represent full-service health plans, health insurers and specialized plans of all sizes on a national basis. In addition, we represent provider organizations, such as IPAs and physician groups. Our experience includes:

Fraud and abuse
Health information and technology
HIPAA and state law privacy and security matters
State HMO and state insurance laws
License applications, material modifications and amendments
Medicaid managed care
Medicare Advantage plans
Mental health parity
New product development
Peer review and credentialing
PPOs, EPOs and ASOs
Specialty health plans (including behavioral health, vision, dental, chiropractic and acupuncture)
Subscriber agreements and evidences of coverage
Discount programs
Disease management
Workers’ compensation

Representative Projects:

Change of Ownership Approvals: Represented a large health plan in obtaining regulatory approvals for change of ownership, in a matter involving substantial public interest and significant regulatory scrutiny.
HIPAA: Represented a large national health care organization in substantial update to company documents to ensure compliance with HIPAA and state privacy and security laws.
Medi-Cal Managed Care: 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.
Peer Review and Credentialing: 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.
Workers’ Compensation: Represented workers’ compensation carrier in establishment of managed care systems and policies in response to recently-enacted reform legislation.