Health Insurance & Managed Care

Managed care continues to have a tremendous impact on health care. Our health law practitioners provide a full range of services related to managed care arrangements including all aspects of HMO and PPO development, acquisition and sale, managed care joint ventures, independent practice associations (IPAs), and physician-hospital organizations (PHOs).

Our services include:

• Determination of appropriate structures and business forms
• Preparation of contracts with providers and payors
• Preparation of contracts with Medicare and federal employees
• Review of fraud and abuse, Stark, and reimbursement issues
• Insurance regulatory compliance and other state department of insurance matters
• Securities exemptions, offerings and registration matters
• Drafting and negotiating managed care contracts (e.g., Preferred Provider Arrangements, Participating Provider Agreements, Network Access Agreements, etc.)
• Form filings with state departments of insurance
• Administrative proceedings before state departments of insurance
• Development of internal policies and procedures for HMOs, PPOs, and other health insurers (e.g., utilization review, internal appeal and grievance procedures, etc.)
• Counsel on federal regulatory law impacting health insurance and managed care (e.g., HIPAA, ERISA, COBRA and Medicare Part D)
• Representing managed care clients in mergers and acquisitions