Represented Inova Health System in negotiating a joint venture transaction with Aetna, a publicly traded insurer, for purposes of setting up jointly owned regional managed care plans and a clinically integrated delivery network.
Represented major health systems in establishing provider-owned health plans for self-funded and fully insured market, including applying for a Certificate of Authority and insurance license.
Represented health insurance clients on offering qualified health plans for health insurance exchange.
Advised employers and employer organizations on implications of employee health plan under Affordable Care Act, essential health benefits, employer mandate, and compliance strategies.
Advised clients on a variety of issues under health care reform including formation of patient centered medical homes and Accountable Care Organizations (ACO), regulatory concerns arising from these new models, and impact of exchange on providers and health plans.
Provided counsel on formation and operation of integrated delivery systems consisting of multiple hospitals, major physician groups, and other health care providers.
Represented provider-owned or affiliated health plans on a wide variety of corporate, operational, and regulatory issues, ranging from structuring financing arrangements among providers and affiliated payers (e.g., revolving loan), establishing management services and other shared services organizations, to advising on Anti-Kickback, Stark, and antitrust issues.
Provided counsel in the acquisition, sale, restructuring, and expansion of managed care plans and approvals from federal and state regulatory authorities.
Provided counsel on formation and operation of life and health, property and casualty insurance companies, and various types of managed care plans such as PPOs, HMOs, and rental and fronting arrangements.
Provided legislative support and expert witness testimony on a variety of provider/payer issues including mandated benefits, credentialing, rental network, and most-favored nation provisions.
Advised clients on programs with federal and state governments such as Medicare Advantage/Prescription Drug Programs, Medicaid managed care plans, and federal employee health care programs.
Provided counsel in negotiating major reimbursement agreements between providers and payers and in the successful resolution of disputes over audits and recovery.
Provided counsel on the formation of health insurance purchasing groups including health insurance alliances and co-ops.