Managed Care

Managed care organizations (MCOs) and health insurers face unique regulatory, legal and economic challenges. Latham & Watkins helps them navigate the evolving landscape of the managed-care and health insurance business.

Why Latham

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.

Comprehensive Expertise

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.

“The timely responses and deep bench of experienced counsel at Latham in many specific areas of healthcare federal and state law is unmatched,” one client reports.

Chambers USA 2020