Healthcare: advice to health insurers in United States
Epstein Becker & Green, P.C.
Self-described healthcare ‘super-boutique’ Epstein Becker & Green, P.C. is well known for its record in M&A, its litigation and investigation practice, and its handling of regulatory matters. In disputes, the team has acted for clients as both plaintiff and defendant. In Washington DC, George Breen, who jointly leads the practice with Mark Lutes, focuses on defending clients in healthcare fraud matters, as do firm co-founder Steven Epstein and office managing partner David Matyas. Jackie Selby, who specializes in managed care, is the key partner in New York. Litigator Anthony Argiropoulos is based in Princeton, New Jersey.
Mark Lutes; George Breen
Manatt, Phelps & Phillips, LLP
Manatt, Phelps & Phillips, LLP has a strong record in M&A, corporate governance, Medicaid redesign, regulatory compliance, and fraud litigation defense including qui tam actions and bad faith denial of benefits suits. Another key area of work is in privacy and security. New York-based Robert Belfort represented Aetna in numerous class actions, individual member lawsuits, and government enquiries alleging that Aetna improperly disclosed members’ HIV-related information. Health group leader William Bernstein, who is based in New York, concentrates on providing strategic and business advice to healthcare clients. The practice also has partners in Los Angeles and Albany.
Other key lawyers:
Robert Belfort; Greg Pimstone
Blue Shield of California
- Represented Blue Shield of California in a suit brought over its Medical Loss Ratio, a provision of the ACA.
McDermott Will & Emery LLP advises healthcare insurers on business transactions, regulatory compliance, litigation, and enforcement. Other areas of strength include work for private equity firms on investing in insurers and advice on healthcare data privacy. The practice has a key litigation component that handles government investigations, voluntary self-disclosures, major investigations, and fraud allegations. Washington DC-based Eric Zimmerman leads the group and focuses on legislative and regulatory matters through lobbying and policy. Kate McDonald, also based in Washington DC, concentrates on federal and state healthcare government programs. The group has partners in Miami, Chicago, Boston, and Los Angeles.
Other key lawyers:
Kate McDonald; Ankur Goel; Jeremy Earl; Gary Scott Davis
- Represented CVS Health Corporation on health regulatory matters in its $69bn acquisition of Aetna.
- Represented venture capital firm Andreessen Horowitz in its investment in Devoted Health.
The healthcare practice at Dentons has a coast-to-coast presence, as well as an office in Honolulu. It has extensive experience in mergers, acquisitions, divestiture and other affiliation transactions, and in the representation of health plans in actions arising from regulatory investigations and violations. Other key areas of work include the formation and licensing of health insurers and managed care organizations, strategic advice on troubled plans, and advice on the Affordable Care Act and its impact on insurers. The team stands out for its strong relationships at state departments of insurance and other regulators. Bruce Baty in Kansas City and Bruce Merlin Fried in Washington DC jointly head the practice.
Bruce Baty; Bruce Merlin Fried
Other key lawyers:
- Represented Hannover Life Reassurance Company of America regarding Medicare Advantage and the use of reinsurance.
- Advised MedPro on regulatory and transactional matters, including the design and implementation of incoming and outgoing reinsurance programs.
- Represented EyeMed Vision Care in its insurance operations, including general regulatory compliance.
- Served as general counsel to the National Association of Accountable Care Organizations.
Gibson, Dunn & Crutcher LLP
The California-based team at Gibson, Dunn & Crutcher LLP focuses on litigation, and has handled matters including reimbursement, coverage issues, class actions, bad faith disputes, and government investigations. Richard Doren, who has a strong record in defeating class certification, represented Aetna in conspiracy claims of systemic underpayment, with plaintiffs claiming damages of over $1.3bn. The practice has also represented employers in disputes over their benefit plans. Heather Richardson has extensive experience in dealing with reimbursement policy, quality of care, provider fraud, and provider contracting.
- Represented Aetna in a long-running ERISA lawsuit for breach of fiduciary duty.
- Represented Cigna in a suit by a chiropractic clinic arising out of Cigna’s administration of an ERISA benefits plan.
- Represented Aetna in a putative class action case regarding a member’s termination of prescription drug benefits.
- Represented Aetna in a putative class action suit regarding Aetna’s overpayment recovery practices.
- Represented United in a putative class action filed by several treatment centers which provide mental health and substance use disorder services.
Greenberg Traurig LLP takes a multidisciplinary approach to regulatory and transactional legal needs in the healthcare space. The practice advises clients on healthcare transactions, including deals involving private equity and other investor groups. On the regulatory side, the team works on matters such as review of Medicare payment and policies, OIG audits and sanctions, state licensure, accreditation, CHOW, and corporate practice of medicine issues. Harold Iselin and Tricia Asaro, with assistance from Eileen Hayes (all three based in Albany), served as outside general counsel to Oscar Insurance Program; significant work including advising on Florida health plan licensing and the ACA. Nancy Taylor in Washington DC and David Peck in Fort Lauderdale jointly head the practice.
Nancy Taylor; David Peck
MVP Health Care
Oscar Insurance Company
The New York Health Plan Association
Texas Association of Health Plans
Wellcare Health Plans
Senior Whole Health
- Represented MVP Health Care in matters including a value-based contracting project, advice on governances, and work on state and federal mental health parity law compliance.
- Represented Podiatry Insurance Company of America in administrative investigations.
- Represented the New York Health Plan in a settlement over coverage of chronic Hepatitis C.
- Served as outside general counsel to Wellcare Health Plans.
- Provided general counsel services to the Texas Association of Health Plans (TAHP) and represented the association before the Texas legislature, Department of Insurance, and other agencies as necessary.
Hogan Lovells US LLP has a strong record in healthcare litigation, including fraud and abuse cases and class actions. In this area, Miami-based Craig Smith represented Amerigroup Florida and UnitedHealthcare of Florida in a putative class action brought by nursing homes and hospice providers of Florida, with hundreds of millions of dollars in potential damages. Other key areas of work are regulatory counseling, privacy work, transactional advice, and dealing with the coverage and reimbursement of new medical therapies. Sheree Kanner leads the practice from Washington DC, and has extensive experience litigating Medicare and Medicaid disputes.
Other key lawyers:
Craig Smith; Robert Leibenluft; Ken Choe; Michael Maddigan
Sunshine State Health Plan
Baptist Health South Florida
Florida Association of Health Plans
Vitality Home Health (d/b/a/ Trilogy Home Health)
Blue Cross and Blue Shield of Florida
Blue Cross and Blue Shield of North Carolina
Community Insurance Company
Celtic Insurance Company
- Represented Centene in a class action lawsuit alleging that its policies have improperly denied them access to certain prescription drugs.
- Represented Health First after it was sued by two physicians alleging that it violated antitrust laws.
- Represented the Florida Association of Health Plans to challenge a proposed Medicaid program rule.
Jones Day’s health insurance transactional practice covers M&A transactions and joint ventures, fraud and abuse regulation, healthcare antitrust, digital health, cybersecurity, tax, and corporate governance. The team is also known for its handling of private equity and bankruptcy matters. San Francisco-based James Dutro, Cleveland-based Stephen Sozio and Washington DC-based Kenneth Field jointly head the practice. Other key names include Lisa Han, who is based in Columbus and has extensive experience in managed care and regulatory compliance, and David Morris in San Francisco, who focuses on complex transactions driven by healthcare payment reform.
James Dutro; Stephen Sozio; Kenneth Field
Blue Cross Blue Shield of Michigan
Southeastern Health Partners
Delta Dental Plan of Michigan, Ohio and Indiana
Tufts Insurance Company
UPMC Health Plan
Blue Cross & Blue Shield of Massachusetts
Delta Dental Plan of Arkansas
Blue Care Network of Michigan
Stanford Health Care
Loma Linda University Health
Cleveland Clinic Foundation
The People’s Choice Hospital
Carolinas HealthCare System
Morgan, Lewis & Bockius LLP has a strong record in complex litigation and class actions, and a robust presence in California. San Francisco-based litigator Molly Moriarty Lane, with assistance from Lisa Weddle in Los Angeles, is defending Cigna in a class action case alleging that Cigna violated California unfair competition law. Other areas of work include transactional and regulatory advice, privacy and security, and government enforcement and compliance matters. Joint practice head Brian Jazaeri represented Health Net of California in a case centering on taxation of California-managed care plans together with Moriarty Lane. Howard Young, who is an expert in healthcare fraud and regulatory issues, co-heads the practice with Jazaeri.
Brian Jazaeri; Howard Young
Health Net of California
Blue Cross Blue Shield of Massachusetts
California Health & Wellness Plan
- Represented Anthem in class actions over health plan coverage for severe mental illnesses.
- Represented Blue Cross Shield of Massachusetts in connection with three class action cases alleging ERISA violations.
- Represented Health Net of California in connection with a demand for arbitration seeking additional reimbursement.
- Represented Blue Cross Shield of Louisiana in connection with its acquisition of majority ownership of Vantage Health Plan.
Reed Smith LLP
Reed Smith LLP’s insurance practice advises on a full spectrum of matters associated with the health insurance managed care industry, including healthcare financing, payment, and reimbursement. Kurt Peterson heads the team from Los Angeles and is experienced in business disputes, fraud and bad faith litigation, and ERISA issues.
Other key lawyers:
Kenneth Smersfelt; Martin Bishop; Bryan Webster
‘Very familiar with the complicated, intricate, and often contradictory nature of our business’
Areas of expertise at Groom Law Group include federal and state healthcare reform laws under the ACA, tax rules that impact the provision of health benefits, state health insurance laws, federal audits, and investigations of health insurers and employers. Practice heads Seth Perretta and Jon Breyfogle advise insurers on aspects of the ACA such as health reform legislative activity. Lisa Campbell has extensive experience in the implementation of ACA market reform enforcement. Ryan Temme was promoted to partner in January 2020. The practice is based in Washington DC.
Jon Breyfogle; Seth Perretta
Blue Cross & Blue Shield Association
America’s Health Insurance Plans
American Benefits Council
- Represented Emblem Health in its attempts to recover several million dollars in unpaid risk corridor obligations under the ACA from the federal government.
- Represented America’s Health Insurance Plans on matters related to health care reform, tax, and ERISA.
Latham & Watkins LLP advises a full spectrum of healthcare clients ranging from early stage and emerging companies to mature, large private and publicly held companies. The team also provides healthcare regulatory advice to life sciences companies including medical device and diagnostic manufacturers, pharmaceutical, and biotech firms. Key names are Washington DC-based Daniel Meron, who specializes in compliance advice and fraud and abuse, managed care expert Daniel Settelmayer in Los Angeles; and David Tolley in Boston who has a focus on Medicaid-related risk adjustments.
SCAN Health Plan
Independent Healthcare Association
- Represented DaVita in the $4.3bn sale of its primary care physician clinics and managed care network business unit to Optum.
- Represented UnitedHealthcare in a false claims act dispute.
- Represented Molina in their sale of Pathways Health and Community Support to Atar Capital.
- Represented Molina in a putative securities class action.
- Represented Credit Suisse as the financial advisor to Anthem on its proposed merger with Cigna.
The healthcare practice at O'Melveny & Myers LLP encompasses a full range of contentious work, such as class actions, multi-district litigation, arbitration, mediations, administrative proceedings, trials, and appeals. The team has a strong record in defending companies against kickback and misbranding claims, state Attorneys’ General actions, and alleged False Claims Act violations. Newport Beach-based practice head David Deaton is defending Molina Healthcare against a False Claims act suit alleging $1bn in Medicare fraud. Other areas of work include advice on government investigation and compliance programs. The group also has offices in Los Angeles and Washington DC.
Other key lawyers:
K. Lee Blalack; James Bowman; Brian Boylr
Cambia Health Solutions
Excellus Health Plan
Health Care Service Corporation
Planned Parenthood Federation of America
- Represented Anthem in its response to a series of DOJ civil investigative demands related to Anthem’s Medicare Advantage risk adjustment practices.
- Secured denial of class certification on behalf of Humana subsidiary in a lawsuit involving sweeping allegations that American Eldercare and other managed care organizations systematically underpaid interest to Florida Medicaid providers.
- Secured dismissal of a putative nationwide class action challenging United’s payment of a royalty to AARP in connection with its AARP-branded Medigap insurance offering.
- Defended United in a putative class action alleging that United improperly denied facility fee payments to office-based surgery practices.
- Represented United in a class action alleging that United violated ERISA requirements relating to the contents of adverse benefit determinations.
Sheppard, Mullin, Richter & Hampton LLP advises clients on transactional and regulatory matters in the healthcare space. Areas of specialism include health plan licensing, reimbursement, fraud and abuse, tax, financing, HIPAA, and privacy. The practice also handles matters such as structuring alliances and joint ventures, leading physician alignment initiatives, and organizing population health management and risk-based reimbursement systems. Los Angeles-based practice head Eric Klein has extensive experience advising US and Chinese healthcare companies and private equity funds in healthcare M&A. The group also has partners in Washington DC, Chicago, Dallas, and New York.
Other key lawyers:
Lynsey Mitchel; Eric Newsom; Christine Clements
Blue Shield of California
Mutual of Omaha
Premera Blue Cross
Kaiser Foundation Health Plan of Washington
Blue Cross Blue Shield of Kansas City
Cambia Health Solutions
CareMore Health (Anthem Subsidiary)
- Advised Blue Shield of California on the launch of its Altais platform, which assists California physician practices with value-based care arrangements.
- Advised Mutual of Omaha on licensure and contracting in connection with its entry into the Medicare Advantage line of business.
- Assisted Dignity Health in obtaining a California Knox-Keene HMO license and continue to advise on ongoing issues connected with HMO operations, including in connection with the merger between Dignity Health and Catholic Health Initiatives.
- Assisted Unum Group, a national employee benefits provider, in its purchase of a dental HMO regulated by the California Department of Managed Health Care.
- Represented Premera Blue Cross in its acquisition from Soundpath (a subsidiary of Catholic Health Initiatives) of approximately 22,000 Medicare Advantage members in several counties in the State of Washington, and obtaining CMS approval of a Service Area Expansion and Novation Agreement to approve the transaction.