Health Plans and Health Insurance

  • Our Healthcare & Life Sciences Team includes dedicated lawyers and professionals who focus on the legal needs of managed care organizations (MCOs).
  • We have wide-ranging experience, from matters concerning HMOs to ERISA plans to pharmaceutical benefits managers, among many others.
  • Our professionals bring real-world MCO experience that includes a keen understanding of the business concerns underlying your legal needs.

In the race to build influence and purchasing power, managed care organizations (MCOs) are consolidating and restructuring yet also expanding product lines at an unprecedented rate. The frenzied pace is not only driving change to federal regulatory activity impacting Medicare law, compliance, HIPAA, antitrust, tax and related policy – it is also spawning (and reacting to) new statewide and regional health insurance laws.

Whether your organization is contemplating reorganization, evaluating a prospective merger and acquisition, or seeking corporate financing, protecting your interests in this fast-changing environment will require seasoned managed care legal counsel.

Holland & Knight’s Health Plans and Health Insurance Group includes more than 30 lawyers dedicated to servicing managed care organizations, their customers and their vendors – from HMOs, health insurers and preferred provider organizations to employer, association and related ERISA plans, to case and disease managers, pharmaceutical benefits managers and third-party administrators, consumer-directed healthcare, managed behavioral health, predictive modeling, e-health and tech companies.

Flexible and Comprehensive Services

From complex trial and appellate litigation involving RICO, ERISA laws, antitrust or tax matters to reinsurance strategies, your Holland & Knight team will advise, guide and safeguard your interests. You will benefit from the group’s substantive knowledge regarding the full spectrum of health insurance-related issues, including the following:

  • contractual negotiations between plans and providers, plans and their customers, and plans and their vendors
  • intellectual property issues unique to health plans
  • premium, capitation and risk pool structure, and actuarial review
  • reimbursement and fraud and abuse matters
  • Medicare Parts C and D (all aspects, including application, bidding, risk adjustment, contracting, compliance, and reimbursement)
  • provider credentialing, HPDB, NPDB and HCQIA issues

Compliance Is Critical

An in-depth understanding of all compliance requirements will help you avoid violations and demonstrate your organization’s commitment to ethical practices, leading to competitive advantages in marketing and sales. The Health Plans and Health Insurance Group includes many national compliance experts, including several former federal prosecutors, former general counsels to state and federal agencies regulating managed care, and in-house lawyers. Our managed care compliance work includes:

  • compliance with licensure, form and rate filings before state departments of insurance, managed care and health
  • maximizing opportunities and compliance with the Medicare Modernization Act (MMA) and the Medicare Advantage Program (previously Medicare + Choice)
  • compliance with Medicare, Medicaid, VA, FEHBP contracting
  • creation of best-in-class corporate compliance programs, policies and procedures

Leadership Roles

Involvement in industry associations and legislative policy expand our knowledge and the resources that become available to you.

  • Health Plans Group attorneys have advocated and drafted key managed care legislation and regulation – such as the disease management and PPO sections of the MMA and the managed care provisions in HIPAA.
  • The team has also worked closely with leaders from most of the managed care and health benefits associations – including NCQA, the Disease Management Association of America, the American Association of Health Plans and the Healthcare Leadership Council.

When Connections Count

Often in managed healthcare, achieving client success depends as much on the quality of government-level relationships as on the law itself. Holland & Knight’s broad national platform has helped our healthcare attorneys build strong relationships with state insurance and managed care regulators. The team works closely with Holland & Knight’s Government Practice, one of the largest and most renowned government relations groups in the U.S.

Often in managed healthcare, achieving client success depends as much on the quality of government-level relationships as on the law itself. Holland & Knight’s broad national platform has helped our healthcare attorneys build strong relationships with state insurance and managed care regulators. The team works closely with Holland & Knight’s Government Practice, one of the largest and most renowned government relations groups in the U.S.

Knowledge Based on the Real World – Your Business World, Not Our Legal World

Making the right legal decisions for your business requires more than ivory-tower knowledge of your industry's legal issues. It takes a hands-on understanding of the daily business issues, as well as fast access to business and accounting experience, financial markets and business partnerships. The firm’s Healthcare Team members come from the industry – many have served as in-house counsel to managed care plans and large provider systems that own their own MCOs, or as venture capitalists, investment bankers and health plan executives. These government and business backgrounds position your Holland & Knight attorneys to prescribe the creative and informed legal solutions that lead to favorable business outcomes.