Managed Care Focus

A Varied, National Practice

We are healthcare lawyers serving dozens of clients across the country. Many of them provide products and services like health insurance, Medicare and Medicaid health plans, pharmaceuticals and healthcare services.

We have experience serving a variety of clients, with special depth of knowledge in assisting:

• Health insurers
• Service providers for government health plans (see explanation below)
• Global pharmaceutical companies
• Investors evaluating compliance requirements

In addition to partnering with in-house counsel and compliance teams, we work closely with senior leadership, management and front-line personnel in Sales and Marketing, Procurement, Appeals, Utilization Management, Customer Service, Claims, and Information Systems.

Supporting Government and Commercial Plans and Service Providers

We have worked closely with Medicare Part D Prescription Drug Plans since the program’s inception in 2006 and we have watched as regulatory and sub-regulatory requirements have grown in complexity for Medicare Part C (Medicare Advantage) and Medicare Part D.

We counsel Medicaid Managed Care plans on day-to-day legal issues, regulatory intricacies and compliance matters. We have extensive experience helping health plans work within the laws and regulations governing Medicare Supplement or Medigap plans. We are deeply aware of the risks plans face and we are prepared to help our clients evaluate and reduce risks that arise in all manner of settings. This includes provider and member relations, joint ventures and vis-à-vis state and federal governments.

We are also a valuable resource for health plan service providers – companies offering supplemental benefits or services to health plans and healthcare providers, including those accepting financial risk. This is especially relevant as lines are beginning to blur between providers and payers. We support and counsel on joint venture and risk sharing arrangements as well as provider-integrated health plans.

Due Diligence for Healthcare Transactions

One other thing worth noting: we often serve as co-counsel in bringing our knowledge of health plan regulations to the table during acquisition transactions. The bottom line: we help firms that otherwise may lack that particular expertise get the deal done.

Industry Acumen

We devote a lot of our time to keeping up with legal and regulatory developments that are likely to affect healthcare companies. As a result, we are just as comfortable discussing regulations and agency views on a granular level as we are understanding the broader context of policy priorities and industry trends.

Put simply, we know your industry like it’s our own. We understand your business challenges and regulatory environment. We know how to protect your interests, whether you’re negotiating a deal or addressing a regulatory matter.

When you work with us, we become part of your legal team, deepening your bench and expanding your knowledge base. We are always happy to work ourselves out of a job by training and equipping your in-house attorneys to handle as much of your plan’s regulatory work as possible. Bottom line: we want your business to succeed.

We Speak Your Language

We know a great partnership starts with clear communication so we work hard to understand your business and speak your language. We strive to make the complex comprehensible and to translate regulatory lingo into plain English. (Once, after conducting a training session around a complex topic, we received the ultimate compliment: “You don’t speak government-ese!”)

We build strong relationships with in-house counsel and compliance officers. And we really thrive when partnering with business teams, leveraging our knowledge of the regulatory environment to give plainspoken, sound counsel. We work especially well with senior leadership, management and front line-level personnel in Sales and Marketing, Procurement, Appeals, Utilization Management, Customer Service, Claims and Information Systems.

We understand you may have budget constraints. Ask us about practical options like packages of services, blocks of hours and fixed-fee arrangements.