Our attorneys work with all types of payors, including health maintenance organizations (HMOs), health plans and health insurers, Medicare Advantage (MA) plans, Medicare prescription drug plans (PDPs), Medicaid state waiver managed care plans (Waiver Programs), self-insured employers, third-party administrators (TPAs), preferred provider organizations (PPOs), exclusive provider organizations (EPOs), workers' compensation managed care organizations (HCOs), state-sponsored universal coverage programs (such as the 2006 Massachusetts Health Care Reform Law), and a variety of other managed care entities.

Our provider clients include institutional and professional providers, multi-specialty medical groups, provider-sponsored PPOs, physician-hospital organizations and arrangements (PHOs and PHAs), nonprofit medical foundations and clinics, independent practice associations (IPAs), provider network management companies and intermediaries, brokers, disease management (DM) companies, utilization review organizations, and peer review agents. 

We assist our clients in dealing with the full spectrum of issues they encounter in the managed care arena, including topics on the cutting edge of law and policy such as non-contracted-provider payment practices, “silent PPOs,” and tiered networks. We also offer advice and representation in a wide variety of day-to-day issues common in the managed care marketplace, including disputes over claims denials and capitation reconciliation, economic credentialing, “any-willing-provider” issues, and managed care contract negotiations.

With a wide range of business, reimbursement, regulatory, contracting, operational, and compliance experience, our attorneys are not only knowledgeable in all areas of legal practice relevant to the managed care industry, but can assist managed care clients with all their business needs, including the formation and licensure/certification of managed care organizations and provider networks, compliance matters, employee benefits, and mergers and acquisitions.