Latham's lawyers represent MCOs, employer-driven, primary care organizations and providers of Medicare Advantage plans. This includes specialized plans, such as Special Needs Plans (SNPs), in some of the most heavily penetrated managed-care markets in the United States.
The firm’s managed-care lawyers assist clients in navigating the politically charged environment with ever-changing regulation and market-driven developments facing the industry.
Latham’s expertise covers both operational concerns, as well as strategic transactions and initiatives, including:
- Compliance under Medicare Advantage and Medicaid managed-care programs
- Intellectual property and trade secret protection
- MCO licensing and regulation
- Mergers, acquisitions and strategic joint ventures
- Plan marketing and regulation of beneficiary arrangements
- Provider contracting, credentialing, payment and billing issues
- Provider reimbursement methodologies (capitation, risk arrangements)
- Solvency issues around statutory capital, risk-based capital (RBC) and tangible net equality (TNE)
- Structuring MCO business entities (health plans, PPOs, IPAs) including employer and employer-sponsored organizations
- Third-party administrators (TPA) regulation, contracting and outsourcing
Latham also has managed-care industry expertise, working with a large variety of prominent MCOs and insurers.