Overview
Stinson's health plan lawyers advise HMOs, health plans and pharmacy benefit managers (PBMs) on transactional, regulatory and governance issues in today's rapidly evolving health insurance marketplace. We frequently handle all manner of transactions, and advise on compliance with state and federal regulations.
HEALTH PLANS TRANSACTIONS
Our team has handled countless health plan and HMO deals from start to finish, including the structuring, negotiation, documents, closing and handling regulatory approvals. We execute strategic affiliations, form innovative partnerships and joint ventures, navigate complex financings, and advise on the full range of mergers, acquisitions and dispositions. Our health plan attorneys combine a deep understanding of both for-profit and nonprofit transactional matters with extensive experience in navigating difficult approval processes. For a few transactions, we have worked closely with regulators to enact legislative authorization for novel transaction structures.
REGULATORY COMPLIANCE
Health plans and HMOs trust Stinson's regulatory counsel to advise on compliance with complex state and federal regulatory requirements, including health insurance regulations, plan structure and design mandates, the Medicare Advantage program, and Medicaid managed care. We stay up to date on often conflicting and ambiguous regulatory statutes and administrative rules, advising clients and addressing regulatory concerns in order to minimize intrusion on business operations and maximize business opportunities.
LITIGATION
Our litigation experience spans a wide range of matters, including governance disputes, antitrust and unfair competition matters, bad faith disputes, institutional issues and market conduct examinations. We frequently defend clients in industry attacks, and represent health plans in attorneys general and other regulatory enforcement proceedings. We work closely with our clients to manage litigation challenges and pursue the most efficient path to success.
NONPROFIT AND TAX-EXEMPT ISSUES
Operating a health plan or HMO within the constraints of a nonprofit and tax-exempt organization requires deep understanding of this unique regulatory and business environment. We help health plans and HMOs navigate attorney general investigation and approval processes and work closely with clients to minimize the adverse effects of these proceedings on business operations. With deep experience in advising 501(c)(3) and 501(c)(4) organizations, we partner with clients on strategic structural and operational decisions to maximize plan growth and community benefit.
