Health care reform and the push for coordinated, “high value” healthcare is increasing the number and complexity of non-fee-for-service arrangements between third party payors, managed care organizations and providers.
Miller Health Law Group attorneys have been advising clients on managed care issues since the “dawn” of the managed care era in California, more than 25 years ago. Our work in the managed care area includes:
- Preparation and negotiation of full medical risk, specialty capitation and preferred provider agreements
- Evaluation of capitation rates and covered services
- Preparation and negotiation of physician services agreements
- Formation of full medical risk and specialty IPAs
- ACO and HMO formation
- Compliance with federal and state laws regulating HMOs and insurance companies
- Handling of provider payment disputes
- Physician credentialing
- Physician “de-selection”
- Advice concerning solicitation of managed care contracts and enrollees
We advised one of two California entities chosen by CMS to receive a first round ACO contract on all legal aspects of their formation and ACO application.