Overview
The Legal 500 US, Healthcare: Health Insurers
Healthcare delivery and reimbursement is shifting toward value-based care and vertical consolidation at a rapid pace, while the boom of health plan mega-mergers shows no signs of stopping. Those who want to grow and innovate within this disrupted healthcare environment face difficult regulatory and transactional legal obstacles. In order to thrive despite these challenges, you must be willing to take calculated business risks and adapt to a shifting landscape.
Creative legal solutions in the most complex markets
Our experienced team anticipates change and crafts creative, strategic solutions in even the most complex markets. Clients turn to us for our depth of knowledge on key issues and our unmatched skill in navigating the complicated industry issues they face, including numerous types of managed care arrangements and integrated delivery systems for health insurers, hospitals, academic medical centers, other institutional inpatient and outpatient facilities, medical groups and independent practice associations, physicians, medical discount programs and employers, as well as for investment bankers, venture capitalists and individual entrepreneurs. Our Firm also works closely with health insurers and their pharmacy benefit managers (PBMs) on prescription drug plans and pricing issues. Amidst uncertainty we offer a level-headed approach, fostering collaboration across industries and borders.
We work tirelessly to facilitate connections through mergers, acquisitions, affiliations and joint ventures, conducting full due diligence while identifying and negotiating arrangements built with regulatory and technological assessments and solutions in mind.
Our team provides guidance to Accountable Care Organizations (ACOs) on the Medicare Shared Savings Program requirements for their organizational and contractual arrangements. We also advise trade associations on communications to their membership regarding legal developments, draft comments on proposed regulations and subregulatory guidance, and offer strategic counseling in dealing with state and federal agencies.
With an impressive depth of national and international regulatory knowledge, we’re at the forefront of health industry innovation. And as the United States’ top-ranked healthcare law firm, we offer unmatched experience addressing the legal obstacles facing health plans, managed care arrangements and ACOs, including providing counsel on:
- Administrative services only arrangements
- Requirements under the Affordable Care Act, such as tax issues and risk management
- Antitrust and trade regulation
- Bankruptcy and workout plans
- Consumer-directed health plans
- Prescription drug pricing
- Conversions and tax-exempt issues
- Corporate integrity agreements and compliance programs
- ERISA
- The Federal Employees Health Benefits Program
- HIPAA privacy and security
- Tiered-benefit arrangements and disease management programs
- Medical discount programs
- The Medicare Advantage Program and Medicare Part D
- Federal and state licensure of plans and insurers
Drawing on our robust, cross-functional, cross-border team, we provide cutting-edge solutions and creative counsel to our health plan clients to navigate the changing healthcare landscape.
