Health Insurance

Nelson Mullins’ Health Insurance Team is well-versed in legal issues affecting the health insurance industry and is experienced in representing health insurance carriers, including regional, national, publicly traded, and mutual companies. This group of practitioners is skilled in health insurance matters ranging from ERISA and complex litigation to government investigations and competitive bid protests and is flexible enough to respond to fast-moving issues that involve multiple legal disciplines. Our work in the health insurance industry combines effective litigation with a deep understanding of the complex regulatory and business environment surrounding health insurance. Our team of attorneys, policy advisors, and e-discovery professionals offers services catered to your needs. We use our substantial experience in this field to provide legal counsel with predictable billing structures, while clearly communicating with you at every stage of the process.

Range of fields

In the challenging environment our clients face, we have the experience and skill set to help clients address legal issues of a broad sphere. Such issues include antitrust, class action defense, cybersecurity and data breach response, e-discovery and litigation readiness, electronic health information, ERISA litigation, Medicare and Medicaid reimbursement, multidistrict litigation, and qui tam actions. 

Interdisciplinary team

With a selection of veteran litigators, our team can help our healthcare insurance clients see around corners and tackle disputes. A wealth of knowledge in negotiating allows the discovery counsel team to advocate to right-size the scope of discovery in significant litigation and government investigation matters. Additionally, former chairmen of government health commissions and nonprofit health organizations contribute to the proficiency of the team, as well as counselors who have been involved with state competitive bidding legislation and advocated options for potential legal challenges.

Our practice group represents clients across the healthcare industry

We have experience representing healthcare insurers of varying sizes, including regional carriers, publicly held national healthcare insurers, and mutual insurance companies. 

Our health insurance practice combines effective litigation with a deep understanding of the complex regulatory and business environment our clients face

Our team of attorneys, policy advisors, paralegals, e-discovery, and other professionals offer reliable services catered specifically to your needs. We use our substantial experience in this field to provide reliable legal counsel with predictable billing structures, while clearly communicating with you at every stage of the process. The end goal is a set of comprehensive, strategic legal solutions that address your legal issues. 

Our team is skilled in health insurance matters ranging from ERISA and complex litigation to government investigations and competitive bidding protests, and is flexible enough to respond to fast-moving issues that involve multiple legal disciplines, including

• Crisis management with a view toward key considerations and strategic positioning for potential litigation blowback
• Litigation defense through deliberate and planned discovery, settlement negotiations, alternative dispute resolution, and — when necessary — trial and appeal
• Time-sensitive investigations, including assisting clients with their internal investigations or responding to government inquiries
• Litigation plans and budgets providing strategic litigation plans and budgets to help rightsize the defense of matters
• Litigation preparedness guidance on practical, repeatable measures and processes to deploy when litigation hits
• Preventative measures to help prevent litigation before it arises

Following is a selected sampling of matters and is provided for informational purposes only. Past success does not indicate the likelihood of success in any future matter.

• Discovery counsel for multiple national healthcare insurance carriers, advising on topics ranging from litigation preparedness to document retention and defensible disposition
• Discovery counsel for over a dozen health insurers brought on behalf of a putative class of healthcare providers and subscribers in a large antitrust multidistrict litigation
• Defended national healthcare insurer in a major ERISA action concerning disputed terms of a short-term disability insurance contract covering thousands of employees
• Represented national healthcare insurer in responding to civil investigative demands issued by the Federal Trade Commission
• Counseled on the applicability of state competitive bidding legislation and provided recommendations on the legal options to a potential legal challenge to the inclusion/exclusion of specific bidding protocols and entities
• Led a statewide challenge to the award of openly bid contracts through the competitive bidding process
• Served as local counsel for the investigation and evaluation of a bid award dispute
• ERISA matters of varying complexity, ranging from benefits disputes to significant plan-level allegations
• Discovery and coordinating counsel for qui tam action alleging Medicare fraud and manipulation of computer source code used in submissions to CMS
• Discovery counsel for a national healthcare insurer in response to DOJ inquiries relating to its merger with another healthcare insurer
• Discovery counsel responding to class action suits regarding a cyber breach relating to compromise of personal information of insureds