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Index of tables

  1. Healthcare: health insurers
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Who Represents Who

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Dentons’ department covers the full gamut of work for health insurers including transactions, regulatory mandates and insurance litigation. In a recent highlight, Bruce Baty and Jodi Adolf in Kansas City advised the Medical Protective Company on the design and implementation of reinsurance programs for healthcare facilities; the pair also acted for Luxottica and EyeMed Vision Care on its vision plans and various compliance issues. Matthew Gaul in New York is a key name for regulatory advice; he recently assisted Berkshire Hathaway with its attempts to bring one of its subsidiaries out of runoff and reactivate its licenses in New York as well as applying for other licenses nationally. Baty and Kara Baysinger in San Francisco jointly lead the group; Baysinger’s expertise includes market conduct and sales practices, licensing matters, reinsurance and transactional work. Other key names include San Francisco-based Michael Barnes and Bruce Merlin Fried in Washington DC.

Trusted Advisor - with Finnegan

IP specialist Finnegan detail how their collaborative approach makes for a unique culture which is designed to allow them to work with clients in a way which is cognizant of the challenges facing all companies today.

Boutique firm Epstein Becker & Green, P.C. is ‘a clear first choice for healthcare work’ with ‘unmatched knowledge and expertise of the field’ across regulatory issues, data privacy matters, government investigations and fraud enforcement work. Practice head George Breen is ‘genuinely brilliant’; his recent mandates include working with David Matyas representing Altegra Health in a Medicare Advantage False Claims Act case relating to alleged fraudulent risk adjustment data which led to inflated capitation payments. Matyas also assisted Envision Healthcare with its merger with AmSurg, Lynn Shapiro Snyder advised the Veterans Accountable Care Group on regulatory issues, and New York-based Leonard Lipsky handled the sale of Virginia Health Network’s stock to MedCost. Clifford Barnes, Steven Epstein and New York-based Jackie Selby are also recommended, and the firm expanded its Nashville office with the recruitment of Richard Westling and Ellen Bonner. All attorneys, unless otherwise specified, are based in Washington DC.

William Bernstein heads Manatt, Phelps & Phillips, LLP’s practice and handles regulatory mandates, transactional issues and funding matters. Other key practitioners include Robert Belfort, who is a ‘leader in healthcare regulatory compliance and transactional work’; Medicaid specialist Cindy Mann in Washington DC; and Los Angeles-based litigator Gregory Pimstone. Pimstone recently defended Blue Shield of California in a putative class action alleging it had incorrectly calculated its medical loss ratio under the Affordable Care Act (ACA); Bernstein and Melinda Dutton assisted the state of North Carolina with the transformation of its Medicaid system; and Bernstein handled Ascension Health’s new Medicare clinician payment methodologies under the Medicare Access and CHIP Reauthorization Act (MACRA). Unless otherwise specified, mentioned attorneys are based in New York.

McDermott Will & Emery LLP’s substantial reputation in the healthcare space allows for a high-profile client roster of national health insurers including Blue Cross Blue Shield of Florida and Humana. Los Angeles-based Paul Carr-Rollitt also advised the Bay Area Accountable Care Network on receiving a restricted Knox-Keene license, while Gary Davis in Miami assisted GuideWell Mutual Holding Corporation with its acquisition of PopHealthCare. Other clients include DaVita, Health First Health Plans and Piedmont WellStar Health Plans. Boston-based team head Stephen Bernstein is a key name in the group; other notable practitioners include Charles Buck in Boston, who focuses on transactions and regulatory compliance; Washington DC-based regulatory specialist Jeremy Earl; and Ankur Goel in Washington DC, who advises on compliance issues and False Claims Act litigation. Joel Michaels retired.

With ‘a practical and business-oriented’ department, Greenberg Traurig, LLP is ‘easy to work with’ thanks to ‘a responsive and proactive approach to its work’. The group is highly regarded for its regulatory expertise; recent mandates include advising Senior Whole Health on contract negotiations and HIPAA compliance, acting for Centerbridge Partners on the regulatory aspects of its acquisition of Davis Vision, and handling the regulatory elements of WellCare Health Plans’ acquisition of Universal American. Nancy Taylor and Michael Cherniga lead the practice from Washington DC and Tallahassee respectively; Taylor is experienced in ACA provisions, reimbursement matters and policy issues, and Cherniga focuses on regulatory mandates. Fort Lauderdale-based David Peck, Tricia Asaro and Harold Iselin in Albany and Francis Serbaroli in New York are also recommended. Albany-based Eileen Hayes made partner in 2017 and Eric Hargan moved in-house.

Under the leadership of Sheree Kanner, Hogan Lovells US LLP’s Washington DC-based department is recognized for its expertise in managed care health plans, fraud and abuse cases, healthcare litigation, policy work and data privacy issues. Kanner regularly litigates Medicare and Medicaid disputes, while Robert Leibenluft is ‘a leading antitrust lawyer’, Ronald Wisor handles regulatory compliance mandates and Miami-based Craig Smith focuses on Medicaid work. Highlights included advising Anthem on an investigation and breach notification following a substantial cyber attack, representing multiple Blue Cross Blue Shield companies in a multidistrict antitrust litigation alleging the client’s license agreements violate federal antitrust laws, and defending Sunshine State Health Plan in litigation against MedOptions relating to unpaid claims. Health Net, Molina Healthcare and Molina Healthcare of Florida are also clients.

Jones Day saw significant changes to its team roster in 2017, with Christopher Anderson joining the Chicago office, Adam Rogers joining the Miami team, and Claire Castles in Los Angeles being promoted to the partnership. James Dutro, Stephen Sozio and Kenneth Field are the team leaders, and are based in San Francisco, Cleveland and Washington DC respectively, also notable are Lisa Han in Columbus and San Francisco-based David Morris. Recent mandates include advising a leading university and its affiliated medical center on the development of an accountable care arrangement, assisting a non-profit health plan with its application for tax-exempt status, and handling the development of an accountable care arrangement for Spirit AeroSystems. Blue Cross Blue Shield of Michigan, Aetna and Stanford Health Care are also clients. Soleil Teubner Boughton moved in-house at Google.

Morgan, Lewis & Bockius LLP is a key name in the market for healthcare litigation, particularly disputes arising from the implementation of the ACA. In a recent highlight, the group represented Anthem in multiple behavioral health class actions relating to the coverage required under the Mental Health Parity and Addiction Equity Act (MHPAEA) for mental illnesses and substance abuse. Further work includes defending Cigna in a class action alleging it violated California’s unfair competition and false advertising laws by making false statements about the scope of its provider network; representing Blue Cross Blue Shield of Massachusetts in a class action alleging ERISA violations; and defending Health Net in a putative class action in which plaintiffs claim it is breaching the terms of its health plan by refusing a prescription request for hepatitis C medication. Howard Young and Brian Jazaeri lead the department from Washington DC and Los Angeles respectively; clients also single out Molly Lane in San Francisco and Washington DC-based Joyce Cowan.

Reed Smith LLP receives ‘the highest possible recommendations’ from its clients thanks to its ‘in-depth experience in litigation and courteous and respectful approach to clients and their situations’. Los Angeles-based practice head Kurt Peterson ‘knows the law inside out’; he recently represented a client in a class action brought by members of ACA plans who allege it modified their health plans. The team also represented an insurer in its attempts to recover its risk corridor payments and represented another client in a putative class action alleging it didn’t properly provide ACA-mandated services. Kenneth Smersfelt in Los Angeles and Martin Bishop in Chicago are also recommended. Bryan Webster joined the Chicago office from McDermott Will & Emery LLP.

Gibson, Dunn & Crutcher LLP’s litigation strength is evident in its recent work for key client Aetna; the group successfully defended it in a putative class action regarding Aetna’s decision to deny coverage for stays at residential treatment facilities and represented it in an appeal challenging an illegal kickback scheme by a Pennsylvania surgery center. Cigna is also a client; the team defended it in litigation relating to ERISA and state law fraud claims. New York-based Adam Offenhartz heads the department, which also includes the highly regarded Richard Doren, class action specialist Geoffrey Sigler in Washington DC, privacy and consumer protection expert Timothy Loose and Heather Richardson, who has handled reimbursement policy mandates, coverage determinations and provider contracts. Unless otherwise specified, mentioned attorneys are based in Los Angeles.

Groom Law Group utilizes its Washington DC base to excel in ACA work and regulatory compliance advice; examples include assisting clients with the impact of attempts to repeal and replace the ACA, advising clients on compliance with the MHPAEA and handling HIPAA privacy and security requirements. The group is also highly regarded for its risk corridor litigation work; it acted for EmblemHealth in its attempts to recover $70m in unpaid risk corridor obligations from the government. Jon Breyfogle and Seth Perretta jointly lead the practice, which fields Lisa Campbell, Thomas Fitzgerald and Tamara Killion as key practitioners.

O'Melveny & Myers LLP’s expertise advising managed care providers includes handling enforcement matters, litigation and Medicare Advantage issues; it recently represented Humana in a False Claims Act case alleging it failed to comply with Medicare Advantage risk adjustment data submission requirements, and defended the same client in a qui tam action alleging the submission of false claims regarding improper diagnosing and coding. Other work includes conducting an internal investigation for a managed care company, defending Humana in a class action regarding alleged artificially inflated prescription drug costs and representing a managed care company in False Claims Act litigation. Anthem, Molina Healthcare, UnitedHealth Group and Planned Parenthood Federation of America are also clients. David Deaton leads the department from Newport Beach; clients also single out Lee Blalack, Brian Boyle and David Leviss in Washington DC.

Eric Klein leads Sheppard, Mullin, Richter & Hampton LLP’s practice from the firm’s Century City office, which leverages a strong California presence to advise clients on California Knox-Keene Act licenses. Further areas of expertise for the team include reimbursement systems, risk-based arrangements, health plan transactions and Medicare and Medicaid health plans. In a recent highlight, Klein and recently promoted partner Lynsey Mitchel advised Fresenius Medical Care on the structuring of a downstream global risk and population health management shared savings program with Humana; the practice also assisted Fidelis Care with its $3.8bn acquisition by Centene and acted for Aledade on the formation of a new Medicare Advantage global risk-focused payor-provider joint venture. Aytan Dahukey, Michael McKinnon in Orange County and New York-based Jay Gerzog are also recommended; Dahukey and McKinnon focus on healthcare transactions, and Gerzog handles hospital acquisitions.

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