The ‘robust‘ team at Manatt, Phelps & Phillips, LLP acts for a lucrative client base which notably includes Blue Shield of California and Aetna Life Insurance Company. William Bernstein leads the New York-based practice with his broad expertise in health service payment issues, and Robert Belfort is known for his vast transactional capabilities, often assisting insurers with value-based arrangements. In Los Angeles, Ileana Hernandez leads the firm’s healthcare litigation group, often acting for insurers and health plans in Employee Retirement Income Security Act (ERISA) cases, while healthcare litigator Gregory Pimstone focuses on FCA and insurance disputes, and Paul Carr-Rollitt regularly advises on the integration of health plans and health systems. Randi Seigel is particularly knowledgeable in matters concerning HIPAA, routinely advising clients on Medicare and Medicaid participation and billing, and Michael Kolber leverages his governmental expertise to assist with corporate transactions and matters concerning commercial managed care.
Health insurers in United States
Manatt, Phelps & Phillips, LLP
Praxisleiter:
William Bernstein
Weitere Kernanwälte:
Robert Belfort; Ileana Hernandez; Randi Seigel; Gregory Pimstone; Michael Kolber; Paul Carr-Rollitt; Rachel Sher; Adam Finkelstein
Referenzen
‘Manatt, Phelps & Phillips, LLP has a robust team with extensive expertise in all fields of the healthcare industry. The team at Manatt is friendly, responsive and professional. No question goes unanswered and every response, project, and other additional support is thoroughly researched.’
‘Rachel Sher and Adam Finkelstein are wonderful collaborators.’
Kernmandanten
Blue Shield of California
Aetna Life Insurance Company
Yale New Haven Health System
New York e-Health Collaborative, Inc.
Memorial Sloan Kettering Cancer Center
Planned Parenthood of Greater New York
Highlight-Mandate
- Represented Blue Shield of California in the second appeal in a long-running case involving a taxpayer’s attempt to force the state of California to tax health care service plans as if they were insurance companies.
- Advising Yale New Haven Health System on its acquisition of two Connecticut health systems from Prospect Medical Holdings, Inc. The firm advised on structuring, negotiating and drafting definitive documents for the acquisition of the health systems.
- Assisting Memorial Sloan Kettering Cancer Center with developing a strategy for continuing to provide cancer services in the home following the end of flexibilities provided during the pandemic.
McDermott Will & Emery LLP
Primarily based in Washington DC, McDermott Will & Emery LLP‘s team handles the full gamut of issues relating to ERISA class actions and M&A for primary care companies, health insurers, and pharmacy benefits managers. Practice head Jerry Sokol works out of the Florida office, and is known for his expansive knowledge of healthcare-related private equity transactions, and Chicago’s Lisa Mazur is a digital health specialist who focuses on professional licensure and reimbursement. Regulatory expert Jeremy Earl often assists insurers with matters governed by the Affordable Care Act, and the interaction between federal standards and state laws regarding insurance, while Kate McDonald is recommended for her expertise in Medicare Advantage, Part D, and managed care matters. Caroline Reignley often handles government investigations and cases relating to the FCA. Anisa Mohanty left the firm in February 2024.
Praxisleiter:
Jerry Sokol
Weitere Kernanwälte:
Jeremy Earl; Kate McDonald; Eric Zimmerman; Lisa Mazur; Caroline Reignley
Referenzen
‘McDermott adopts a tailored approach, ensuring that its legal solutions are not only legally sound but also aligned with the unique challenges and opportunities within clients’ industries. Their practice integrates legal expertise with a deep understanding of technology, business, and regulatory landscapes. This holistic approach allows McDermott to provide comprehensive guidance.’
Kernmandanten
CVS Health
Antidote Health
Prime Therapeutics
Novant Health
Solaris Health
Summit Health – City MD
Vytalize Health
Ascend Healthcare
HIG
Unified Women’s Healthcare
Beth Israel Lahey Health
Highlight-Mandate
- Advised CVS Health on the acquisitions of Oak Health Street, Carbon Health, and Signify Health, providing regulatory advice.
- Advised Geisinger Health, a provider, health insurer, and medical school, on its acquisition by Kaiser Permanente.
- Advised Prime Therapeutics on the $1.35bn acquisition of Magellan RX Management.
Dentons
Kimberly Kerry and Janice Ziegler jointly co-head the practice at Dentons, which is known for its strong capabilities in claims regarding insurance fraud. Dividing her time between San Francisco and Oakland, Kerry is known for her vast corporate expertise within the healthcare space, and Michael Barnes is a key name for claims-handling and coverage mandates. Ziegler works out of the New York office, advising health plans, insurers, and insurance brokers on regulatory issues, and Sean Cenawood utilizes his expansive governmental expertise to assist with both internal and government investigations. In Washington DC, Bruce Merlin Fried is a key contact for health plans and physician organizations, while Christopher Janney has longstanding expertise in M&A and clinical arrangements for marketing and services, and Gadi Weinreich is noted for his deep knowledge of whistleblower claims. Commercial litigation expert Dianne Winter Brookins often acts in disputes concerning insurance coverage and benefits in Honolulu.
Praxisleiter:
Kimberly Kerry; Janice Ziegler
Weitere Kernanwälte:
Bruce Merlin Fried; Christopher Janney; Gadi Weinreich; Sean Cenawood; Margo Wilkinson Smith; Dianne Winter Brookins; Michael Barnes
Kernmandanten
Shamir
UCare
HCA
LA Care
Covered California
District of Columbia Health Benefit Exchange
NationsBenefits
Selective Insurance
Highlight-Mandate
- Represented Shamir in a qui tam False Claims Act litigation filed in the US District Court for the Central District of California.
- Advised UCare on federal government relations and healthcare regulatory issues.
- Advised HCA Holdings on Medicare and Medicaid, fraud and abuse, regulatory, operational, and compliance issues.
Epstein Becker & Green, P.C.
The varied offering at Epstein Becker & Green, P.C. handles the full range of life sciences and healthcare-related mandates. Mark Lutes and George Breen co-lead the team from Washington DC, while Amy Dow heads up the group from Chicago. Dow is well known for her expertise in the life sciences industry, often assisting private equity clients and pharma companies; Breen is a seasoned litigator who focuses on FCA and privacy related disputes; and Lutes is noted for his longstanding knowledge of the regulatory regimes governing investments into the healthcare and life sciences industries. Steven Epstein is also a key name within the practice. Eric Neiman, Emma Pelkey, and Sharon Peters joined the Portland team from Lewis Brisbois Bisgaard & Smith LLP in July 2023, contributing their respective knowledge of provider operations, EMTALA issues, and patient and workforce matters.
Praxisleiter:
Mark Lutes; George Breen; Amy Dow
Weitere Kernanwälte:
Steven Epstein; Jackie Selby; Gregory Epstein; Jason Christ; Eric Neiman; Emma Pelkey; Sharon Peters; Kevin Malone
Greenberg Traurig LLP
Greenberg Traurig, LLP‘s New York group is renowned for its broad experience, advising a diverse client list of pharmacy benefit managers, insurance companies, and health plans. Practice co-head Tricia Asaro routinely acts for health plans in corporate governance and compliance mandates, while Harold Iselin is noted for his knowledge of insurance and managed care transactions. David Peck co-heads the practice from Florida, often assisting private equity houses and high growth companies with corporate issues. Eileen Hayes has notable regulatory expertise in health insurance, drawing on her prior experience in the New York insurance department within the Department of Financial Services’ Health Bureau. Elizabeth Sacco regularly acts for specialty network providers and insurers in both federal and state level regulatory mandates concerning licensing issues.
Praxisleiter:
Tricia Asaro; David Peck
Kernmandanten
Affinity Health Plan
MVP Health Care
MetroPlus Health Plan Inc.
Oscar Insurance Corporation
New York Health Plan Association
United HealthCare
Centene
Longevity Health Founders
Aetna
ProAssurance
Texas Association of Health Plans
Hamaspik Choice
SantaFe Healthcare
ArchCare
Highlight-Mandate
- Advised Affinity on its sale to Molina Healthcare, Inc. and the distribution of the proceeds of the sale to community-based organizations through a grant program approved by the Attorney General of the State of New York.
Hogan Lovells US LLP
Hogan Lovells US LLP routinely acts for insurers in coverage disputes and cybersecurity matters, in addition to advising clients on HIPAA compliance. Leading the practice from Washington DC, Ronald Wisor has extensive expertise in healthcare fraud and abuse matters. Miami’s Craig Smith represents a number of major health plans and systems in Medicare and Medicaid-related mandates, while David Massey is well versed in disputes involving ERISA and FCA violations. Litigator Michael Maddigan often acts in class actions and insurance disputes in Los Angeles. The Washington DC group was bolstered by the arrival of Kenneth Field from Jones Day, who adds his extensive knowledge of antitrust issues within the healthcare sphere.
Praxisleiter:
Ronald Wisor
Kernmandanten
UnitedHealth Group
Optum
Globe Life, Inc.
Kaiser Permanente
Parker Jewish
AgeWell New York, LLC
Molina Healthcare of Florida
UnitedHealthcare of Florida
CIGNA Healthcare
Blue Cross and Blue Shield of Florida, Inc.
Highlight-Mandate
- Represented UnitedHealthcare in various lawsuits across the country, including Florida and California. The matters were successfully resolved in favor of the client.
- Advised Kaiser Permanente on the creation of Risant Health, a new subsidiary to which Kaiser expects to commit $35-50bn to acquire health systems in various parts of the US.
- Representing Molina Healthcare in a class action lawsuit filed by Comprehensive Pathology Associates alleging that Molina Healthcare’s Florida Medicaid health plan failed to comply with Florida law by not covering certain hospital-based pathology services.
O'Melveny & Myers LLP
Primarily based in California, the practice at O'Melveny & Myers LLP stands out for handling a vast array of disputes and regulatory issues for health plans and insurers, and healthcare companies. Practice co-head David Deaton has ample experience in conducting internal investigations and acting in both federal and state enforcement inquiries. Lee Blalack, a seasoned commercial litigator, co-heads the team from Washington DC, acting for insurance and physician staffing companies. Caitlin Bair is an expert in FCA and Anti-Kickback matters, while Stephen Sullivan focuses on handling Medicare Advantage issues for managed care organizations. Elizabeth Bock is a key name within the practice for ACA and Medicare Advantage risk adjustment matters.
Praxisleiter:
David Deaton; Lee Blalack
Referenzen
‘The firm tries to find business solutions to complicated processes.’
‘What makes them standout is their availability. Your problems are their problems and they take them seriously.’
Kernmandanten
America’s Health Insurance Plans
American Hospital Association
Blue Cross Blue Shield of North Carolina
Cambia Health Solutions
CareSource
Clover Health
CVS Healthcare
Elevance Health, Inc.
Excellus Health Plan, Inc.
Health Care Service Corporation
Horizon Blue Cross Blue Shield of New Jersey
Humana Inc.
Johnson & Johnson
Janssen Pharmaceuticals
Kaiser Foundation Health Plan
Molina Healthcare
Planned Parenthood Federation of America, Inc.
UnitedHealth Group
UnitedHealthcare Insurance Company
Highlight-Mandate
- Representing Kaiser Foundation Health Plan, Inc. and various Kaiser Permanente entities in FCA litigation which originated after the filing of six FCA qui tam actions, which were consolidated in the Northern District of California under United States ex rel. Osinek v. Kaiser Permanente. The DOJ intervened in part in all six qui tams, alleging that the parties submitted false claims for Medicare Advantage payments by improperly adding diagnosis codes through medical record amendments.
- Representing Elevance Health, Inc. and its Florida subsidiary, HealthSun Health Plans, Inc., in a criminal investigation by the DOJ involving alleged Medicare fraud at HealthSun, which has focused on HealthSun’s submission of allegedly fraudulent risk adjustment data to CMS, resulting in approximately $53m in overpayments from CMS. The DOJ formally declined to prosecute HealthSun.
- Representing Humana in its affirmative lawsuit under the Administrative Procedure Act challenging the federal government’s reversal of a policy governing payment audits conducted by the Medicare Advantage program.
Reed Smith LLP
The ‘truly amazing‘ California-based team at Reed Smith LLP focuses on a broad array of managed care issues within the healthcare industry. In Chicago, practice head Martin Bishop is noted for his longstanding experience in managed care-related class actions and common law claims, and Rebecca Hanson has expansive knowledge of managed care disputes involving the ACA and ERISA. Kurt Peterson acts for health plans and insurers on the full range of risk management and professional liability issues, while Kenneth Smersfelt regularly defends clients in claims brought by government agencies and regulators. The ‘outstanding‘ Amir Shlesinger is a seasoned litigator who has vast expertise in reimbursement and member direct-pay disputes, and Karen Braje often assists insurers with mandates concerning allegations of bad faith denial of benefits.
Praxisleiter:
Martin Bishop
Weitere Kernanwälte:
Kurt Peterson; Kenneth Smersfelt; Karen Braje; Amir Shlesinger; Will Sheridan; Rebecca Hanson
Referenzen
‘Reed Smith has the best practice representing health insurers in the US. Their knowledge of the industry is beyond impressive. There is not an issue that crosses my desk that they have not seen before. It is truly amazing.’
‘The bread and depth of the managed care lawyers at Reed Smith really stands out. Their substantive expertise goes across all the myriad issues we face.’
‘Will Sheridan is so knowledgeable that he was able to get us an injunction literally in one day. My business folks were beside themselves with glee. He just knew the arguments and issues in a nanosecond.’
Sheppard, Mullin, Richter & Hampton LLP
Praised by clients for its ‘wealth of deep understanding‘, the California-based practice at Sheppard, Mullin, Richter & Hampton LLP handles a broad array of mandates, including the taxation of health plans and disputes concerning out-of-network reimbursement. Eric Klein leads the team, utilizing his longstanding transactional experience to advise clients on joint ventures and M&A. Lynsey Mitchel is a regulatory specialist when it comes to HMO-related issues under the California Knox-Keene Health Care Service Plan Act, while Moe Keshavarzi routinely acts for health plans in class actions and disputes concerning unfair competition. W0rking out of the Washington DC office, Christine Clements is known for her broad knowledge of HIPAA compliance issues and both state and federal managed healthcare government contract programs.
Praxisleiter:
Eric Klein
Referenzen
‘The team brings a wealth of deep understanding in our industry, along with a vast wheelhouse of internal resources for any issues that crop up. Knowing there is a subject matter expert for the unique issues we are presented with brings us the confidence that we do not need to engage another firm to help with the consistency across issues.’
‘The clarity of response, quickness of reply, and personalities of the people we work with (particularly Christine Clements) have brought us back time and time again.’
‘Christine Clement’s deep understanding of the industry has brought us confidence, and helped propel our business in the right direction.’
Kernmandanten
Molina Healthcare
Centene Corporation
Kaiser Foundation Health Plan
UnitedHealthcare
UAW Retiree Medical Benefits Trust
Hawaii Medical Service Association
Chicago Pacific Founders
California Association of Health Plans
Multiplan, Inc.
Oscar Health, Inc.
Highlight-Mandate
- Advised Molina Healthcare on the negotiation of the contracts between the state of California, Molina Healthcare and, HealthNet within six weeks in order to meet state-imposed deadlines for launch of the newly redesigned 2024 Medi-Cal California program. The contract is expected to provide $3.9bn in revenue to Molina.
- Advised Centene’s Wellcare Health Plan on the negotiation of a strategic alliance with Mutual of Omaha for the launch of co-branded Medicare Advantage plans across the US starting in 2024.
- Represented Kaiser Foundation Health plan in a taxpayer suit which alleged that Kaiser should have been taxed as an insurance company, which under the California Constitution would have required Kaiser to pay tax not on profits but instead on gross premium revenue. The case presented the novel issue of whether a healthcare service plan is the same thing as a health insurance company for purposes of the California Constitution’s gross premium tax provision.
Gibson, Dunn & Crutcher LLP
Gibson, Dunn & Crutcher LLP‘s broad team is well known for its insurance expertise, handling a range of investigations and actions concerning FCA and Anti-Kickback violations. Geoffrey Sigler co-leads the team from Washington DC, while Deborah Stein leads from Los Angeles. Sigler regularly handles class actions concerning behavioral care coverage under ERISA, and allegations involving the underpayment of plan benefits.
Praxisleiter:
Geoffrey Sigler; Deborah Stein
Kernmandanten
United Healthcare
UnitedHealth Group
United Behavioral Health
AIU Insurance Company
National Union Fire Insurance Company of Pittsburgh, PA
PacifiCare Life and Health Insurance Company
State Farm Life Insurance Company
Gold Coast Health Plan
Healthcare Partners
Presbyterian Health Plan
Groom Law Group, Chartered
Seth Perretta and Lisa Campbell jointly lead the Washington DC-based group at Groom Law Group, Chartered, which acts for a diverse client list of employers, sponsors of health and welfare plans, and managed care organizations. Campbell is an expert in all matters ACA related, with an emphasis on qualified health plan standards and insurance market reforms, while Jon Breyfogle is particularly knowledgeable on ERISA fiduciary rules, advising a number of health insurers and trade associations on health matters. Ryan Temme often advises health plan sponsors and insurers on compliance with both federal and state regulations regarding the Mental Health Parity and Addiction Equity Acts. Perretta is known for his deep knowledge of employee benefits issues, including health reimbursement arrangements, and Xavier Baker routinely assists clients with disputes concerning non-discrimination requirements under the ACA.
Praxisleiter:
Seth Perretta; Lisa Campbell
Weitere Kernanwälte:
Ryan Temme; Xavier Baker; Kathryn Bjornstad Amin; Jon Breyfogle
Latham & Watkins LLP
John Manthei, Ben Haas, and Jason Caron lead the team at Latham & Watkins LLP from Washington DC. The group handles a variety of issues, from qui tam actions to coverage disputes. Boston’s David Tolley acts in a broad range of disputes concerning FCA and Anti-Kickback rules, often representing insurers and hospital systems. In Washington DC, Daniel Meron utilizes his prior government experience within the HHS to advise on fraud and abuse, and white-collar enforcement issues within the healthcare space.
Praxisleiter:
John Manthei; Jason Caron; Ben Haas
Weitere Kernanwälte:
David Tolley; Daniel Meron
Kernmandanten
Cigna
Warburg Pincus
UnitedHealth Group Inc.
Independent Health Association Inc.
Highlight-Mandate
- Representing Cigna in connection with over a dozen insurance coverage matters and disputes, including opioid-related lawsuits, and lawsuits and demands involving the Department of Justice in connection with the DOJ’s increased enforcement efforts under the False Claims Act.
- Representing UnitedHealth Group, Inc. in ongoing FCA litigation related to UnitedHealth’s Medicare Advantage plans. The firm is acting in a reverse false claims act claim and two common law claims for payment by mistake and unjust enrichment.
- Representing Independent Health Association in a multi-defendant qui tam FCA action regarding IHA’s risk adjustment diagnostic coding practices.