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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Press Releases

Stites & Harbison Increases Rank on ABA Health Law Section’s Regional Top 10 List for 2020

LOUISVILLE, Ky.—The American Bar Association (ABA) Health Law Section has ranked Stites & Harbison, PLLC in 6th place in its Eighth Annual Regional Law Firm Recognition List for the South region for 2020.

by Stites & Harbison, PLLC April 14, 2021
Press Releases

Stites & Harbison Promotes Three Attorneys

LOUISVILLE, Ky.—Stites & Harbison, PLLC announced today that three attorneys have been promoted within the law firm effective January 2021.

by Stites & Harbison, PLLC January 04, 2021
Client Alerts

Joint Agency Cyber Alert Warns of Imminent and Credible Ransomware Threat Against U.S. Health Care and Public Health Sectors

A joint cybersecurity advisory alert issued October 28, 2020, warns of an imminent cybercrime threat to the U.S. health care sector.

by Sarah Cronan Spurlock, Ian T. Ramsey, and Dustyn B. Jones November 02, 2020