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
Main Contact
See more related to Health Insurance & Managed Care
Events

Kentucky Health Law Institute

Date: 9/2/20 - 9/3/20
Time: 8:00 a.m. - 5:00 p.m.

WEBINAR (via Zoom)

Sarah Spurlock, Janet Craig and Dustyn Jones will be presenters at this WEBINAR presented by UK Law Continuing Legal Education on September 2-3, 2020.

Sarah Cronan Spurlock, Janet A. Craig, and Dustyn B. Jones June 30, 2020
Client Alerts

Healthcare Fraud and Abuse Laws are Relaxed During COVID-19

In response to the global COVID-19 pandemic, on March 30, 2020, the Secretary of the Department of Health and Human Services (HHS) issued nationwide blanket waivers of sanctions under the federal physician self-referral law (Stark Law) for “COVID-19 Purposes” (Blanket Waivers).

by K. Kelly White Bryant and Ozair M. Shariff April 13, 2020
Press Releases

Stites & Harbison ranks 7th in ABA Health Law Section's Regional Top 10 List for 2019

LOUISVILLE, Ky.—The American Bar Association (ABA) Health Law Section has ranked Stites & Harbison, PLLC in 7th place in its Seventh Annual Regional Law Firm Recognition List for the South region for 2019. This year marks Stites & Harbison’s sixth consecutive time being named to the Top 10 list.

by Stites & Harbison, PLLC November 05, 2019