The complexity of the health care delivery system, particularly as we head into the new age of health care reform, leads to many disputes between health plans and providers, between health plans and members, and between health plans and regulators. As a law firm focused on representing health plans, health insurers, and other health care payors, we offer the depth and breadth of experience necessary to assist our health plan clients in their litigation matters. Whether in state or federal court, arbitration, or an administrative forum, our litigators bring considerable knowledge regarding the practical implications of health plan litigation to every case.
With a wealth of licensing experience, including attorneys who have worked for the Department of Managed Health Care, we are uniquely positioned to assist health plans, health insurers, and other health care payors through the complicated regulatory and legal issues distinct to our clients, including licensing and compliance. Whether it is heightened government scrutiny or creative industry practices, we advise our health plan clients to compete effectively in the complexity that is health care regulation and compliance. Our experience before state and federal regulatory agencies has established our attorneys as among the most accomplished in the area of regulatory practice.
Our firm represents more than half of California’s Medi-Cal managed care plans, including Commercial Plans, Local Initiatives, and County Organized Health Systems, operating in nearly 40 counties. We provide everyday advice and counsel pertaining to the complex matrix of state and federal Medicaid laws and have a proven track record of success in litigation against the Department of Health Care Services.
From time to time, our clients find themselves in the cross-hairs of state or federal regulators, including the Department of Managed Health Care and the Department of Insurance. Whether the client’s goals are to resolve an enforcement matter or defend an unwarranted action by a regulator, our firm has had great success representing health payors in their unique relationships with their regulators.
We offer an exceptional capacity to represent health care clients in the regulatory setting, including challenging government regulatory action. With a wealth of experience litigating in the administrative forum, including a stable of attorneys who have worked for government regulators, we thoroughly understand the legal principles governing agency conduct that is so critical to successfully challenging agency action. Our track record of success before state and federal regulatory agencies has established our attorneys as among the most accomplished in the area of administrative law and regulatory practice.
DSR currently provides the following legal services to California health plans:
- Litigation (provider disputes, member disputes, etc.)
- Contract review/drafting (provider contracts, vendor contracts, MOUs, online privacy statements, etc.)
- Medi-Cal advice and counsel
- Medi-Cal rate-setting disputes
- DMHC regulatory advice and counsel (including audits)
- DMHC enforcement actions
- DMHC licensing
- Covered California advice and counsel
- Federal Medicare and Medicaid advice and counsel
- ERISA advice and counsel
- HIPAA compliance
- Grievances and administrative proceedings
- Provider fair hearings
- Arbitrations
- Mediations
- Writ Proceedings
- Subpoenas and other records requests (including Public Records Act requests for our public agency clients)
- Other civil court matters (federal and state)
