Health Care Insurance Regulation

The rapidly growing maze of federal and state regulations impacting health carriers, managed care organizations and other entities regulated by state insurance agencies can be intrinsically daunting but also presents opportunities. Regulated entities are rethinking how they do business in the context of an evolving health care industry, marked by state exchanges, Medicaid expansion and the growth in Medicaid managed care organizations, the integration of behavioral and physical health care delivery, pay-for-performance arrangements, and an increasingly innovative dynamic between health carriers and health care providers.

Key Contacts

Susan Fine Of Counsel Seattle, WA
Maren R. Norton Partner Seattle, WA
Overview

Our experienced insurance regulatory attorneys advise health insurers, health plans and other entities regulated by state insurance agencies as they navigate the complex web of regulations applicable to virtually every aspect of their businesses.  We are pragmatic and translate legal requirements into real-world solutions. Our services include strategic guidance related to licensing and registration, compliance with state insurance laws and regulations, financial filings, health practitioner and facility contracting, and mergers and acquisitions. We have significant experience with Medicaid and Medicare and regularly counsel Medicaid managed care organizations and Medicare Advantage plans on reimbursement issues, fraud, waste and abuse, and general compliance matters.

We proactively engage with regulators, legislators and policymakers to remain abreast of emergent industry developments.  Our team and clients are well-positioned to play meaningful roles in shaping the regulatory landscape.  We represent health plans in informal negotiations with agency officials and with respect to market conduct and financial exams. Our proactive engagement on behalf of our clients often results in the avoidance of formal enforcement actions when compliance issues are identified. When formal disputes arise, we offer skillful representation in administrative proceedings and litigation.

Our Services

  • Licensing, registration and certification for insurers, health plans and third-party administrators
  • Insurer Holding Company Act compliance
  • Administrative actions and enforcement proceedings
  • Counseling and advice regarding statutory and regulatory requirements
  • Regulatory filing and financial reporting
  • Financial and market conduct examinations
  • Insurer and health plan acquisitions, joint ventures and restructuring
  • Behavioral and physical health integration and service delivery
Matters
  • Represented a private company operating Medicaid and Medicare health plans in connection with the sale via merger of all of its common stock to a publicly traded health plan provider.  The transaction required approval from the Oregon Insurance Division. 
  • Successfully represented an insurance carrier in an administrative hearing challenging denial of approval of health plans for inclusion in the Washington Health Exchange.
  • Successfully challenged disapproval of association health plan rate filings.
  • Guided an Oregon-based health plan through corrective action process and restructuring of compliance program.
Team
Insights & Presentations
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