Matters
- Manage multiple national Third Party Administrator licensing and license renewal projects, including projects for offshore clients.
- Provide ongoing regulatory and compliance advice and counsel to national third party administrator clients, including filing requirements, contracts, compliance issues, complaints, audits, investigations, and ERISA issues.
- Analyze application of state insurance laws for large health organizations contemplating forming clinically integrated networks or accountable care organizations in various states to determine whether state insurance laws may require licensure or registration. Assist other entities forming provider networks to comply with preferred provider organization (PPO) or intermediary licensure or registration requirements.
- Provide regulatory advice and counsel to pharmacy benefit managers (PBMs), including assistance with licensing, compliance, contract drafting and negotiations, and regulatory inquiries.
- Provide licensing and regulatory advice and counsel to national DMPOs, including review of sales and marketing materials.
- Provide licensing and regulatory advice and counsel to national utilization review organizations.
- Provided regulatory advice and counsel to numerous insurance company clients with respect to various market conduct examinations, including several multi-state or national market conduct examinations.
- Served as regulatory counsel for a health insurer and HMO offering on and off Exchange plans, including annually updating policy forms, providing advice regarding the application of health insurance laws and the ACA, and assisted with responses to complaints and DOI inquiries.
- Drafted and filed amendatory endorsements and conducted national nonrenewal and market exit of grandfathered health insurance plans on behalf health insurance company.
- Led team that updated national health insurer’s compliance database to incorporate all state mandated benefits and to address jurisdictional issues.
- Conducted review of national health insurer’s sales and marketing materials, including field-created ads, on a 50-state basis.
