Healthcare: health insurers in United States
The coast-to-coast practice at Dentons advises health insurers on corporate transactions and licensing matters, ensures their compliance with national programs and also represents them in audits, investigations and other types of litigation. Bruce Baty, who chairs the insurance regulatory practice group from the firm's Kansas office, advised MedPro on the design and implementation of several programs for healthcare providers and captive insurers, among other matters,. while the core team also includes Washington DC-based Bruce Merlin Fried, who serves as general counsel to the National Association of Accountable Care Organizations, as well as Michael Barnes in San Francisco. The practice recently expanded its presence into the Hawaii market via a combination with Honolulu firm Alston Hunt Floyd & Ing in May 2018, a deal which saw the addition of partners including Dianne Winter Brookins and John-Anderson Meyer. Kara Baysinger, who previously co-led the firm's global insurance sector team, left for Mayer Brown in March 2019.
Epstein Becker & Green, P.C.
Alongside workforce management and litigation, healthcare law constitutes one of the three areas of focus for Epstein Becker & Green, P.C. , which describes itself as a "super-boutique". While best known for handling M&A transactions, regulatory matters, fraud and abuse issues, government investigations and litigation, the team also advises on data privacy matters and private equity transactions. In Washington DC, health care and life sciences chair George Breen, firm co-founder Steven Epstein and office managing partner David Matyas primarily advise on healthcare fraud matters, while managed care specialist Jackie Selby and litigator Anthony Argiropoulos are the respective key partners in New York and New Jersey. Lynn Shapiro Snyder, who is also based in Washington DC, is known for her advice on regulatory matters relating to third-party payment programs.
The 'superbly prepared and highly knowledgeable team' at Manatt, Phelps & Phillips, LLP, which is active in more than thirty states, offers strategic and regulatory advice on healthcare reforms, compliance, privacy and technology matters, as well as M&A transactions. Another key area is litigation, where the firm's lawyers are considered to be 'tough adversaries', but also 'maintain constant civility during proceedings'. In New York, Robert Belfort served as regulatory counsel to Humana during its acquisitions of hospice providers Kindred and Curo, while health group leader William Bernstein advised Molina Healthcare on its participation in the Medicaid, Marketplace and Medicare programs. In Los Angeles, John LeBlanc and Greg Pimstone lead the healthcare litigation practice, with prominent work including defending Aetna against multiple class actions on a state and national level concerning an alleged improper disclosure of HIV-related information, with Matt Kanny taking a lead role.
Operating on the 'leading edge' of the industry', McDermott Will & Emery LLP 'has compiled a team of experts covering every aspect of healthcare law'. It is known for advising on the regulatory aspects of major M&A deals, such as CVS Health's $69bn acquisition of Aetna, which saw Chicago-based Joan Polacheck lead a team including Washington DC partners Kate McDonald, Ankur Goel and Jeremy Earl. Other main areas of expertise include dispute resolution in relation to government investigations, anti-kickback rules and reimbursement laws, healthcare advocacy efforts, as well as data breach and digital health matters. Together with LA-based trial lawyers Tom Ryan and Greg Jones, Chicago antitrust partner Stephan Wu represented The Permanente Group against a hospital group which accused the client and its insured of creating a healthcare monopoly in California. In Boston, the 'excellent' global practice group leader Stephen Bernstein and 'world-class subject matter expert' Christopher Jedrey are recommended, while 'leading healthcare compliance lawyer' Eric Gordon in Los Angeles is another name to note.
Gibson, Dunn & Crutcher LLP
Gibson, Dunn & Crutcher LLP's work for health insurers focuses on contentious matters, including nationwide class actions, coverage disputes, healthcare payment and reimbursement litigation, as well as allegations of bad faith. A major recent example was Los Angeles partner Richard Doren's successful representation of Aetna after a $1.3bn putative class action was initiated by health plan members and providers who accused Aetna of underpayment for services delivered by out-of-network providers. Other active clients include Cigna and PacifiCare Life and Health Insurance Company. Heather Richardson (also located in Los Angeles) and Washington DC partner Geoffrey Sigler are other key members of the team. Insurance litigator Deborah Stein joined the Los Angeles office from Simpson Thacher & Bartlett LLP in January 2019.
Greenberg Traurig LLP's health insurance practice advises on the regulatory aspects of M&A and investment transactions, including Medicare payment and policies, audits and sanctions, as well as state licenses and accreditation. In a recent highlight, Nancy Taylor in Washington DC acted as regulatory counsel for Centerbridge Partners on its acquisition of a majority stake in Davis Vision from Highmark Health. On the litigation side, Joseph Coniglio in Dallas defended the Podiatry Insurance Company of America against a range of lawsuits, while Albany-based Harold Iselin continued to serve as general corporate and regulatory counsel for both Oscar Insurance and MVP Healthcare. Alongside Iselin, Tricia A Asaro and Eileen Hayes also form part of the team in Albany.
Led by Sheree Kanner out of the Washington DC office, Hogan Lovells US LLP's health insurers practice covers transactions, policy initiatives, coverage and reimbursement matters, compliance and internal investigations, as well as False Claims Act litigation and class action defence. Miami-based Craig Smith and Allen Pegg are advising three Florida Medicaid health plans - Amerigroup Florida, Sunshine State Health Plan and UnitedHealthcare of Florida - against a putative class action brought by a consortium of nursing homes. Washington DC-based Craig Hoover is leading a team representing eleven Blue Cross Blue Shield (BCBS) companies in closely watched litigation over whether BCBS license agreements violate federal antitrust laws. Los Angeles managing partner Michael Maddigan and his team regularly advise on complex commercial disputes, including helping to secure a California Court of Appeal victory for Anthem.
Jones Day's health insurer practice advises on a broad range of issues, including M&A transactions and joint ventures, regulation, antitrust, IT, cybersecurity, tax, labor and employment and corporate governance, as well as high-stakes litigation. San Francisco-based partner David Morris advised Centura Health on the formation of a joint venture with health insurer Anthem in relation to the transformation of Colorado's Medicaid program, while Lisa Han in Columbus assisted non-profit organization Carolinas HealthCare System on shared savings programs for its clinically integrated network Carolinas Physicians Alliance. Another recent highlight was the representation of Cardinal Health in the sale of its majority stake in naviHealth, led by Jeffrey Litle in Columbus and Daniel Michaels in Washington DC.
In the healthcare space, Morgan, Lewis & Bockius LLP is best known for advising healthcare clients on class actions, Affordable Care Act litigation, transactions and compliance matters, as well as regulatory and data privacy issues. Los Angeles partner Brian Jazaeri and San Francisco commercial litigator Molly Moriarty Lane are defending Health Net of California in a dispute over taxes owed to various state agencies, which could total as much as $10bn, while Blue Cross Blue Shield of Massachusetts is another key client the firm has been defending against class actions. The firm's transactional and contentious practice capabilities received a major boost in early 2018 by the arrival of six former Baker & Hostetler LLP partners.
Reed Smith LLP
Reed Smith LLP offers advice on both contentious and non-contentious healthcare matters, including transactions, antitrust and government investigations, as well as handling consumer class actions and bad faith and contractual claims within the managed care industry. The core team has a presence in California, Illinois and Pennsylvania, which includes, among others, Los Angeles-based contract and payment litigators Kurt Peterson and Ken Smersfelt, Washington DC life sciences health industry group co-chair Scot Hasselman, and managed-care trial attorneys Marty Bishop and Bryan Webster, who both sit in Chicago.
The health and welfare practice at Groom Law Group impresses with 'in-depth knowledge, creative thinking and high awareness of market trends'. The team, which mainly acts for institutional clients and public sector employers, specialises in advising on federal healthcare reforms, including the Affordable Care Act, as well as issues relating to Medicare, privacy and security, ERISA and the Anti-Kickback Statute. Other practice areas include M&A and advocacy, while the firm also advises on the development of new products and services. Seth Perretta and recommended partner Jon Breyfogle provide general ACA regulatory guidance, including advice on the impact of federal payments on cost-sharing reductions, while Thomas Fitzgerald currently represents Emblem Health in its attempt to recover $70m in unpaid risk corridor obligations from the federal government. America's Health Insurance Plans is another longstanding client of Perretta's. Other notable partners include Tammy Killion, Lisa Campbell and Rachel Levy. The firm's sole office is located in Washington DC.
The healthcare practice at Latham & Watkins LLP handles M&A transactions on both a corporate and regulatory level, while also advising clients on government investigations, financing, compliance, fraud and abuse, program reimbursement, licensure issues and managed care matters. In a major highlight, Washington DC partner Daniel Meron successfully advised UnitedHealthcare on its challenge to an administrative payment rule within the Medicare Advantage program which determined overpayments on the basis of adequate documentation within patients' medical charts. Daniel Settelmayer in Los Angeles assisted Molina Healthcare on the sale of multi-state service provider Pathways Health and Community Support to Atar Capital.
O'Melveny & Myers LLP's healthcare scope ranges from M&A, corporate and intellectual property to the implementation of compliance programs and government investigations, class actions and multi-district disputes. A team led by Newport Beach-based practice head David Deaton is currently defending Anthem against a series of DOJ civil investigative demands regarding its Medicare Advantage risk adjustment practices. Other names of note include trial lawyer Lee Blalack and False Claims Act specialist David Leviss in Washington DC, as well as managed care expert Stephen Sullivan in the Los Angeles office. Litigator Kevin Feder, who is also based in Washington DC, was promoted to the partnership in 2018.
With particular expertise in health management, risk-based arrangements and reimbursement systems, the 'professional, responsive and helpful' healthcare practice at Sheppard, Mullin, Richter & Hampton LLP has a nationwide industry presence with offices in Los Angeles, Chicago, New York, Dallas and Washington DC. Its portfolio of services covers corporate and financing transactions, regulatory and compliance disputes, licensing and governance issues, as well as access to ancillary practices such as tax, IT, employment and real estate law. Century City partners Eric Klein and Lynsey Mitchel assisted Mutual of Omaha with the investment and contractual aspects of its entry into the Medicare Advantage business. Another highlight for Klein was client Premera Blue Cross' acquisition of approximately 22,000 Medicare Advantage members from Soundpath. San Francisco-based corporate lawyer Eric Newsom and federal healthcare specialist Christine Clements in Washington DC joined from Manatt, Phelps & Phillips, LLP and Crowell & Moring LLP respectively in spring 2018.