Managed Care & Indemnity Insurance

Working closely with the Firm’s Insurance Practice Group, our Health Care Practice Group attorneys provide the full range of services necessary to help managed care organizations (MCOs), indemnity insurers, and third-party administrators (TPAs) understand and comply with the complex array of laws that regulate the health insurance industry.  For example:

• The Firm assists MCOs in the development, acquisition and sale of HMOs, PPOs, IPAs, and PHOs, as well as in contract negotiations with health care providers and State and Federal health care programs. 
• Sonnenschein provides counsel regarding ERISA preemption, product development (including drafting self-insurance programs and coverage policies), form and rate filings, market conduct and financial examinations, the acquisition and disposition of commercial and Medicaid/Public Aid books of business, change of control filings, and the sale and marketing of insurance over the Internet, including licensing and compensation requirements and restrictions.
• Firm attorneys represent MCOs and indemnity insurers in connection with litigation and administrative, civil and criminal audits and investigations.  This includes actions alleging improper coding, reimbursement, and violations of Federal and State fraud and abuse, privacy, and Medicare Secondary Payer laws and regulations.
• The Firm develops tailored corporate compliance programs for insurers and facilitates the implementation of these programs by providing training and education to compliance officers, in-house counsel, management, and reimbursement and marketing personnel. 
• Sonnenschein provides advice on a variety of risk management issues, including the development of claims investigation procedures, and the analysis of health plan policies under relevant fraud and abuse laws. 
• The Firm provides educational training sessions, conducts “gap” analyses, examines business arrangements for regulatory compliance, and drafts privacy notices, business associate agreements, and other HIPAA-related documents for MCOs, indemnity insurers and TPAs.