Managed Care

Representation of Managed Care Organizations (MCOs), such as HMOs, insurers, IPAs, MSOs, and provider networks requires a through understanding of the applicable federal and state laws and regulations. Issues from the negotiation of payment arrangements with payors, the creation of provider contracts, the conductance of audits to ensure plan compliance and the need to perform contract terminations confront MCOs on an on-going basis.

Burnham Brown attorneys have counseled MCOs from their initial creation through their development into viable health care participants. Our attorneys are also trained to recognize the interrelated legal challenges that accompany these organizations, like capitalization, ERISA, insurance, employee benefit, governance, and fraud and abuse issues. Burnham Brown attorneys have recently handled the following matters:

  • Assisted in the creation of several Independent Practice Associations, and served as their general counsel
  • Developed primary care physician and specialty care physician agreements
  • Negotiated capitation payment arrangements with payors
  • Provided legal opinions and represented MCOs during physician contract terminations
  • Research and drafted strategic law plans for development of MCOs
  • Provided advice and counsel for health care organizations regarding Unfair Business Practices Act claims

 

Representation of Managed Care Organizations (MCOs), such as HMOs, insurers, IPAs, MSOs, and provider networks requires a through understanding of the applicable federal and state laws and regulations. Issues from the negotiation of payment arrangements with payors, the creation of provider contracts, the conductance of audits to ensure plan compliance and the need to perform contract terminations confront MCOs on an on-going basis.

Burnham Brown attorneys have counseled MCOs from their initial creation through their development into viable health care participants. Our attorneys are also trained to recognize the interrelated legal challenges that accompany these organizations, like capitalization, ERISA, insurance, employee benefit, governance, and fraud and abuse issues. Burnham Brown attorneys have recently handled the following matters:

  • Assisted in the creation of several Independent Practice Associations, and served as their general counsel
  • Developed primary care physician and specialty care physician agreements
  • Negotiated capitation payment arrangements with payors
  • Provided legal opinions and represented MCOs during physician contract terminations
  • Research and drafted strategic law plans for development of MCOs
  • Provided advice and counsel for health care organizations regarding Unfair Business Practices Act claims

 

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