Managed Care Organizations (HMO/Knox-Keene Entities)

Nelson Hardiman represents limited Knox-Keene licensees and health maintenance organizations (HMO’s), including several Medicare Part C plans.  Nelson Hardiman counsels and assists limited Knox-Keene and HMO entities with a wide range of business, regulatory, and strategic challenges, including:

  • Business Transactions
    • Formation of entities and business structure for managed care entities
    • Knox-Keene and Department of Managed Health Care (DMHC) license application requirements
    • Management Service Organization (MSO) relationships with Knox-Keene entities
    • Purchase and sale of managed care entities
    • Network and physician contracts
  • Regulatory Defense
    • DMHC investigations and hearings
    • Reimbursement audits and investigations by governmental payors, including Medicare and Medi-Cal
  • Compliance
    • Medicare Part C compliance counseling
    • Knox-Keene compliance counseling
    • HIPAA and state patient data privacy and security requirements
  • Litigation
    • Reimbursement disputes
    • Business litigation, including partnership disputes