Industry: Managed Care Organizations

PPSV offers managed care organizations experienced counsel in connection with a wide range of legal issues and provides assistance to providers who contract with health plans or establish their own health plans.  We provide services on behalf of providers, provider networks, third party administrators (TPAs)/utilization review organizations, pharmacy benefit managers and disease management organizations.  Our representation has included:

• Representing clients with respect to the Medicare Advantage program, Federal Employee Health Benefits Program (FEHBP), Medicare Part D, Medicare demonstration projects, CHAMPUS/TRICARE, and various Medicaid managed care programs.
• Assisting clients in corporate formation of managed care organizations and networks, including state regulatory compliance.
• Offering our attorneys’ extensive experience with respect to federal and state regulatory matters, such as federal and state program requirements, fraud and abuse, privacy and security, antitrust, ERISA and healthcare policy.
• Representing clients in administrative proceedings, OIG and other government audits and investigations, and in court in connection with actions involving alleged improper procedures and regulatory violations.
• Providing advice regarding mergers, acquisitions, sales and reorganizations.
• Meeting with HHS, CMS and state agencies regarding regulatory and compliance issues that clients confront.