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HEALTH CARE INSURANCE

As health care providers explore new compensation and reimbursement models, many are engaging in business opportunities that require knowledge of, and experience in, Medicare and Medicaid statutes and regulations, as well as state insurance laws. Over the years our attorneys have worked with a number of Medicare and Medicaid managed care plans gaining an extensive working knowledge of the laws governing such plans.

Our attorneys also routinely:

  • Interact with state Departments of Insurance on our clients’ behalf to assist with licensure requests, insurance form filings, and the acquisitions and divestitures of health plans
  • Establish partnerships with payers and employers on risk contracting, allowing providers to assume accountability for care in acceptable risk constructs
  • Analyze current relationships for affiliated networks and integrated delivery systems relating to managed care contracting and other risk arrangements (e.g., Medicare shared savings programs, bundled payment for care improvement initiatives)
  • Assist in researching and analyzing state agent and producer insurance laws and in maintaining pharmacy benefits manager, third-party administrator, and utilization review licenses

Our attorneys have long represented commercial and managed care plans in many types of lawsuits. We have substantial experience defending claims arising from denial of a claim and third-party administrator decisions. We have also represented managed care organizations in lawsuits against governmental agencies and other complex contract actions.

Publications

Unlocking the Code to a Successful Acquisition of AI Technology

Illinois legislature makes substantial limiting changes to state law on non-compete and non-solicitation agreements

You just received a grand jury subpoena. Now what?

EEOC issues new guidance on COVID-19 vaccinations in the workplace

What can recent FCA decisions tell us about the Seventh Circuit pleading standard for health care billing fraud claims?

Missouri legislature passes new protections for businesses from COVID-19 suits

The NCAA Implements a Four Corners Offense As it Postpones NIL Rule Changes

OSHA issues new guidance on face coverings in light of COVID-19

Federal agencies announce expedited antitrust procedures for COVID-19 public health efforts

Seven things employers should know about Medicare for All

Surprise billing legislation: What employers need to know

When should you terminate a defined benefit plan? Four influential factors

Bifurcated trials: A road map for better results for insurers facing non-ERISA disability claims

5 takeaways from the employee ERISA win in McMillan

In California, when is a ‘worker’ considered an ‘employee’?

Criminal antitrust prosecutions still loom for employers with ‘no-poaching,’ ‘wage-fixing’ agreements

Supreme Court clarifies definition of ‘church plan’ under ERISA

Grant and cooperative-agreement recipients: Are your procurement standards compliant yet?

21st Century Cures Act overrules IRS guidance on HRAs, enhances enforcement of Mental Health Parity Act

5 tips for environmental due diligence in business transactions

Recent guidance issued on mental health parity and tobacco cessation programs

Missouri to join Right to Work ranks: Is the fight over or just warming up?

EEOC issues guidance on new wellness notice mandated for 2017

Are HR employees ‘investment advisors’ under the DOL’s fiduciary rule?

Did you consider the COBRA implications of your severance arrangement?

Key considerations for representation and warranty insurance

New Illinois law prohibits non-competition agreements with low-wage employees

IRS releases updated safe harbors for management contracts in tax-exempt bond-financed projects

New OSHA reporting and anti-retaliation rules

IRS releases final forms for Health Care Reform reporting

Two key legislative developments impact wellness plans, non-qualified deferred compensation plans

U.S. Supreme Court strikes down DOMA: What it means for plan sponsors

Blog Posts

Health Care Mergers at Risk: New Guidelines Enhance Agencies’ Powers to Challenge Mergers

Class Actions Highlight AI-Assisted Payer Denials

OIG Update Modernizes Compliance Program Guidance

OCR Issues New Telehealth Guidance

OCR Issues New Telehealth Guidance

Upcoming Changes to Various Federal Laws Impacting the Health Care Industry

OIG Publishes New “Featured Topic” on Managed Care Oversight

Welcome to Digital Health Dispatch

Subjective Intent in False Claims Act: Navigating Ambiguity in Health Care Reimbursement Claims

Illinois Passes Legislation Requiring Attorney General Notice of Certain Health Care Transactions

TCLE

Better Together? Competition, Price Gouging and Other Antitrust Issues Raised by the COVID-19 Pandemic

Ethics and Cybersecurity

Overtime Law 2016 – Expanded New Rule: What It Means for You

News

Evan Goldfarb Named to Health Care Law 2024 Power List

John Howard Shares Five Models for Structuring Health Provider-Payor Partnerships

Tonya Oliver Rose Discusses When to Tap Legal Counsel

Thompson Coburn Bounds into 2024 with Lateral Additions, Continuing its National Growth

Mackenzie Wallace Co-Authors ABA Book on Managed Care Reimbursement

Milada Goturi Discusses Best Practices for Addressing HIPAA Violations with Healthcare Risk Management

Evan Goldfarb Discusses Leadership Journey with Corporate Counsel

Partner Susan Fisher Named a Top 50 Attorney of Dallas by Attorney Intel

Mackenzie Wallace and Ashton Dietrich Discuss CMS Final Rule on Prior Authorizations

Mackenzie Wallace Discusses Biden Administration's Short-Term Health Plan Proposal

Claire Schenk Elected Chair of the Board of Casa de Salud

Suzanne Galvin Quoted in Bloomberg Law Regarding Revised PFAS Settlement

Evan Goldfarb Named a 2023 Women, Influence and Power in Law Award Winner

Provident Behavioral Health Makes Strategic Decision to Acquire Assets from Care and Counseling

Chambers USA Recognizes Thompson Coburn Practices for Excellence in 2023 Guide

Mackenzie Wallace discusses the latest trends and challenges facing today's health care market on AHLA podcast

Health care attorney Bryan Gray Looney joins Thompson Coburn

Thompson Coburn attorneys recognized in 2022 Chambers USA

Thompson Coburn presents ‘The Wraparound’ at the 2022 CLOC Global Institute

Health care litigators recoup significant insurance payments for Vibra Healthcare, other providers in 2021

Thompson Coburn is Texas proud after first year in Dallas

Health care litigator Mackenzie Wallace joins Thompson Coburn in Dallas

Thompson Coburn client Charles Rice wins 2020 Nobel Prize for Hepatitis C Virus discoveries

Nicole Jobe named a 2020 Missouri Up & Coming Lawyer

Congratulations to our 14 ‘Lawyers of the Year’ for 2020

Claire Schenk imparts life (and rock climbing) advice in UMSL commencement speech

Tonya Oliver Rose rejoins Thompson Coburn’s health care practice

Congratulations to our 14 'Lawyers of the Year' for 2018

Evan Goldfarb named a 2017 Women’s Justice Award winner

Thompson Coburn named among top 30 law firms for client service

St. Louis Business Journal honors Thompson Coburn for outstanding wellness initiatives

A merger story: Tom Minogue and Jack Musgrave discuss 20 years as Thompson Coburn

Claire Schenk to moderate Missouri Bar Health and Hospital Administration panel presentation

Thompson Coburn earns corporate counsel recommendations five years running in national report

Thompson Coburn earns eight national top-tier rankings in U.S. News ‘Best Law Firms’ survey

Thompson Coburn represents issuer in 2014 Health Care Deal of the Year

Claire Schenk to speak at 10th Annual ABA National Institute on False Claims Act

Thompson Coburn secures Illinois appellate victory for community hospital

Missouri Supreme Court sides with Mercy Hospital St. Louis in class action over billing practices

Jan Paul Miller quoted in St. Louis Business Journal on Glaxo health care fraud settlement

Thompson Coburn handled The Bond Buyer’s 2011 Health Care Deal of the Year

Associate
Chicago

Raquel focuses her practice on corporate and regulatory matters within the health care sector.

Raquel focuses her practice on corporate and regulatory matters within the ...

Raquel Boton
Partner
St. Louis

Cathy focuses her practice on employee benefits, taxation and closely-held businesses.

Cathy focuses her practice on employee benefits, taxation and closely-held ...

Cathy Conrad
Associate
Dallas

Ashton is a perceptive litigator with experience in health care litigation, tort and product liability, and complex commercial disputes.

Ashton is a perceptive litigator with experience in health care litigation,...

Ashton Dietrich
Associate
St. Louis

Jesse represents and leads clients through sophisticated mergers and acquisitions, equity financing transactions, and securities offerings.

Jesse represents and leads clients through sophisticated mergers and acquis...

Jesse Doggendorf
Partner
Dallas

Jenny is an experienced and strategic trial lawyer focusing her practice on health care, social justice, white-collar fraud and complex commercial litigation.

Jenny is an experienced and strategic trial lawyer focusing her practice on...

Jennifer Ecklund
Partner
St. Louis

Jeff helps all types of businesses navigate complex litigation, arbitration, class action, regulatory, and transactional matters in venues across the country.

Jeff helps all types of businesses navigate complex litigation, arbitration...

Jeff Fink
Partner
Dallas

Susan is a versatile corporate attorney who represents public and private companies, portfolio companies, private equity funds, and individual and institutional investors...

Susan is a versatile corporate attorney who represents public and private c...

Susan Fisher
Senior Counsel
St. Louis

Jim serves as a key advisor to regional medical groups on the full spectrum of business and regulatory issues they encounter while providing medical services.

Jim serves as a key advisor to regional medical groups on the full spectrum...

Jim Fogle
Partner
St. Louis

Suzanne is a versatile litigator who finds creative solutions for clients facing difficult and protracted legal battles.

Suzanne is a versatile litigator who finds creative solutions for clients f...

Suzanne Galvin
Partner
Dallas

Ryan is an experienced employment law attorney who serves as a trusted advisor and effective litigator for employers of all sizes.

Ryan is an experienced employment law attorney who serves as a trusted advi...

Ryan Gehbauer
Partner
St. Louis

For more than 30 years, Evan has served as a trusted advisor to hospitals, health care systems, long-term care facilities, health plans, physicians, and other businesses ...

For more than 30 years, Evan has served as a trusted advisor to hospitals, ...

Evan Raskas Goldfarb
Partner
Chicago

Jay serves as a critical business partner and advisor for a variety of companies, from startups to multi-level international organizations.

Jay serves as a critical business partner and advisor for a variety of comp...

A. Jay Goldstein
Partner
Washington, D.C.

Hospitals, health systems, physicians and other health care clients look to Milada, an attorney and registered nurse, for critical assistance on a range of complex regula...

Hospitals, health systems, physicians and other health care clients look to...

Milada Goturi
Partner
St. Louis

Ed is a veteran litigator and head of the Firm's Antitrust Practice Group.

Ed is a veteran litigator and head of the Firm's Antitrust Practice Group.

Ed Harvey
Partner
St. Louis |
Los Angeles

Joy advises health systems, health plans, group purchasing organizations, physician groups, and other health care entities on a wide range of health care legal issues.

Joy advises health systems, health plans, group purchasing organizations, p...

Joy Harris Hennessy
Partner
St. Louis

As a former health care executive and health system general counsel, John has a unique perspective on the types of legal counsel health care organizations need to achieve...

As a former health care executive and health system general counsel, John h...

John Howard
Partner
St. Louis

Nicole advises health care providers and health plans on structuring transactions and analyzes health care regulatory issues with an eye toward effective, proactive compl...

Nicole advises health care providers and health plans on structuring transa...

Nicole Jobe
Partner
New York

James serves as legal adviser to investors, entrepreneurs, investment advisers and investment bankers as they fund or invest in new companies, grow established private co...

James serves as legal adviser to investors, entrepreneurs, investment advis...

James Kardon
Associate
St. Louis

Kevin provides strategic legal counsel to health care clients on a broad spectrum of matters.

Kevin provides strategic legal counsel to health care clients on a broad sp...

Kevin Kifer
Associate
St. Louis

As a former health care executive, April strongly connects to the complex issues facing health care clients.

As a former health care executive, April strongly connects to the complex i...

April Kirkley
Partner
St. Louis

Brian is a business litigator representing plaintiffs and defendants in complex commercial litigation and internal compliance issues across many industries.

Brian is a business litigator representing plaintiffs and defendants in com...

Brian Lamping
Partner
St. Louis

Michael's practice is focused on providing practical, comprehensive solutions that meet the business goals of clients in the employee benefits area of human resources law...

Michael's practice is focused on providing practical, comprehensive solutio...

Michael Lane
Partner
St. Louis

Rick advises companies and individuals on a variety of federal (domestic and international), state and local tax matters.

Rick advises companies and individuals on a variety of federal (domestic an...

Rick Lawton
Partner
St. Louis

Tom is Co-Chair of Thompson Coburn LLP's Corporate Department.

Tom is Co-Chair of Thompson Coburn LLP's Corporate Department.

Tom Litz
Partner

Bryan provides strategic counsel on a variety of issues affecting health care industry clients, including participation in alternative payment models and other value-base...

Bryan provides strategic counsel on a variety of issues affecting health ca...

Bryan Gray Looney
Partner
St. Louis

Krissa practices human resources law, focusing on the representation of employers in employment litigation and client counseling.

Krissa practices human resources law, focusing on the representation of emp...

Krissa Lubben
Partner
St. Louis

Greg represents clients in mergers and acquisitions and sophisticated securities offerings, and offers advice on the wide range of regulatory and compliance issues affect...

Greg represents clients in mergers and acquisitions and sophisticated secur...

Greg Mennerick
Associate
St. Louis

Benjamin Middleton assists clients in a variety of litigation and regulatory matters in state and federal courts as well as in front of federal agencies.

Benjamin Middleton assists clients in a variety of litigation and regulator...

B.I. Middleton
Partner
St. Louis

Jan is a former United States Attorney with extensive trial experience who represents companies and individuals in major litigation and regulatory actions.

Jan is a former United States Attorney with extensive trial experience who ...

Jan Paul Miller
Partner
Chicago

Matthew represents public and private companies across the country on a wide range of corporate matters while providing comprehensive advice on corporate and business iss...

Matthew represents public and private companies across the country on a wid...

Matthew Misichko
Partner
St. Louis

Tonya provides sensible, strategic and holistic guidance to health care clients related to health care regulatory and compliance issues, government investigations and tra...

Tonya provides sensible, strategic and holistic guidance to health care cli...

Tonya Oliver Rose
Partner
St. Louis

Claire is a litigator focusing in health care fraud and abuse, False Claims Act litigation, and other complex white-collar litigation.

Claire is a litigator focusing in health care fraud and abuse, False Claims...

Claire Schenk
Associate
St. Louis

Amy advises employers on retirement plans, health and welfare plans, compensation packages and other benefits.

Amy advises employers on retirement plans, health and welfare plans, compen...

Amy Dygert Stansfield
Partner
St. Louis

Brent helps his clients navigate the complexities of mergers, acquisitions, financings, and other significant corporate transactions from initial negotiation through exec...

Brent helps his clients navigate the complexities of mergers, acquisitions,...

Brent Trame
Associate

Taylor counsels health care clients with respect to day-to-day regulatory and operational compliance, contracting, and transactional matters.

Taylor counsels health care clients with respect to day-to-day regulatory a...

Taylor Trippe
Partner
Chicago

Nathan advises both buyers and sellers in a range of sophisticated M&A transactions, including private equity and strategic acquisitions, divestitures, and leveraged ...

Nathan advises both buyers and sellers in a range of sophisticated M&A ...

Nathan Viehl
Partner
Dallas

Mackenzie is an experienced trial attorney representing health care entities, businesses, and directors in high-stakes litigation.

Mackenzie is an experienced trial attorney representing health care entitie...

Mackenzie Wallace
Partner
Dallas

Nicole is a highly experienced trial lawyer representing clients in matters involving antitrust, advertising, business divorces and disputes, fraud investigations and lit...

Nicole is a highly experienced trial lawyer representing clients in matters...

Nicole Williams
Partner
Dallas

Dawn defends major product manufacturers and chemical distributors in products liability and mass tort litigation.

Dawn defends major product manufacturers and chemical distributors in produ...

Dawn Wright
Partner
St. Louis

An experienced litigator, Maria defends clients in banking and fiduciary matters in Missouri state and federal courts, as well as courts around the country.

An experienced litigator, Maria defends clients in banking and fiduciary ma...

Maria Zschoche