Health (Managed Care)

 

• Representation for developing managed care network formation, independent physician associations (IPAs), physician-hospital organizations (PHOs), medical group leases, services contracts, employment agreements, physician contracting, physician employment, group practice, mergers and acquisitions, provider deselection from managed care networks, licensure applications, regulatory investigations, alternative dispute resolution (ADR) and litigation involving issues such as bad faith claims, medical liability, payer audits and recoupments, contractual reimbursement, 340B Drug Pricing Program, and prompt pay penalty disputes with provider groups, hospitals and hospital systems.

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• Consultation regarding Essential Health Benefits (EHBs), Qualified Health Plans (QHPs), Medical Loss Ratio (MLR), Health Plan Identifiers (HPIDs), Other Entity Identifiers (OEIDs), Health Plan and Other Entity Enumeration System (HPOEES) and other health-related issues.

 

• Consultation for managed care companies regarding the creation of business relationships, the design of marketing and network joint ventures, and in provider contracts of all types, including capitation and risk arrangements.

 

• Representation of claimants and payers regarding various government payers such as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) (now TRICARE), Department of Veterans Affairs, Medicare, Medicare Advantage, Medicaid and the Federal Employee Health Benefits Program (FEHB).

 

• Structured and negotiated joint ventures and agreements with health care providers, administrative service providers and other vendors, to create integrated delivery systems. 

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    Last updated 210509_1451