Managed Care Regulatory, Compliance & Operations
Overview
Our attorneys provide managed care regulatory, compliance and operations advice to health plans, health insurers, third party administrators and provider organizations of all sizes on a national basis. Several of our attorneys have significant government agency experience. Our experience includes:
- ERISA
- 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, ASOs and MEWAs
- Specialty health plans (including behavioral health, vision, dental, chiropractic and acupuncture)
- Subscriber agreements and evidences of coverage
- Discount programs
- Disease management
- Utilization Review and medical bill review
- Workers’ compensation
Our representative projects include:
- Change of Ownership Approvals: Represented numerous large and small health plans and insurers in obtaining regulatory approvals for changes of ownership.
- Medicaid 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 review and analysis of managed care systems and policies, including utilization review, PPO networks and medical bill review.
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