Insurance Regulatory

Health Insurance & Managed Care

Managed care continues to have a tremendous impact on health care. Our health law practitioners provide a full range of services related to managed care arrangements including all aspects of HMO and PPO development, acquisition and sale, managed care joint ventures, independent practice associations (IPAs), and physician-hospital organizations (PHOs).

Our services include:

  • Determination of appropriate structures and business forms
  • Preparation of contracts with providers and payors
  • Preparation of contracts with Medicare and federal employees
  • Review of fraud and abuse, Stark, and reimbursement issues
  • Insurance regulatory compliance and other state department of insurance matters
  • Securities exemptions, offerings and registration matters
  • Drafting and negotiating managed care contracts (e.g., Preferred Provider Arrangements, Participating Provider Agreements, Network Access Agreements, etc.)
  • Form filings with state departments of insurance
  • Administrative proceedings before state departments of insurance
  • Development of internal policies and procedures for HMOs, PPOs, and other health insurers (e.g., utilization review, internal appeal and grievance procedures, etc.)
  • Counsel on federal regulatory law impacting health insurance and managed care (e.g., HIPAA, ERISA, COBRA and Medicare Part D)
  • Representing managed care clients in mergers and acquisitions
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Articles

No-fault insurance in Kentucky

House Bill 151, “An Act Relating to Insurance Fraud,” was signed by the Kentucky Governor on March 26, 2019 and went into effect on June 27, 2019.

by K. Kelly White Bryant and Sarah Cronan Spurlock July 09, 2019
Press Releases

Dustyn Jones selected for Elevate Kentucky Class of 2019

LEXINGTON, Ky.—Leadership Kentucky recently selected Stites & Harbison, PLLC attorney Dustyn Jones as one of 25 participants for the Elevate Kentucky Class of 2019.

by Stites & Harbison, PLLC April 18, 2019
Press Releases

Kentucky Super Lawyers Honors 42 Stites & Harbison Attorneys for 2019

LOUISVILLE, Ky.—The 2019 edition of Kentucky Super Lawyers recently honored 42 Stites & Harbison, PLLC attorneys in the Covington, Frankfort, Lexington and Louisville, Ky., offices. The publication named 33 attorneys to the Super Lawyers list and nine attorneys to the Rising Stars list.

by Stites & Harbison, PLLC December 07, 2018
Press Releases

Stites & Harbison Ranks 5th in the ABA Health Law Section's Regional Top 10 List for 2018

LOUISVILLE, Ky.—The American Bar Association (ABA) Health Law Section has ranked Stites & Harbison, PLLC as 5th in its annual “Regional Law Firm Recognition Top 10 list” for the South region for 2018. This year...
by Stites & Harbison, PLLC October 25, 2018