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.

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.

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