Education

  • University of Iowa, B.B.A. (1982)
  • Marquette University Law School, J.D. (1985)

Admissions

  • California

Peter Roan

Partner
proan@crowell.com
+1.213.443.5571

Health care plans and organizations threatened by daunting litigation and regulatory challenges rely on Peter Roan to find creative solutions and achieve victories. His clients include managed care organizations at the forefront of the industry, and over three decades Peter has accumulated a particularly deep understanding of managed care businesses and the challenging regulatory environments they face.

Peter’s clients include managed care organizations, health benefit plans, and Medicare Advantage organizations; Medicaid managed care plans; insurers, plan administrators, and plan sponsors; physician organizations; other health care providers and suppliers; ambulatory surgical, skilled nursing, and other health care facilities; and trade associations in various litigation and regulatory matters. His litigation experience includes payer/provider disputes and commercial litigation as well as defending consumer class actions, managed care liability, bad faith, wrongful death, ERISA, unfair business practices, False Claims Act, and RICO cases. Peter represents health care payers that offer or administer group and individual insurance as well as organizations participating in government-sponsored or subsidized health programs, including Medicare Advantage, Medicaid, TRICARE, and FEHBP. He counsels clients on regulatory and business matters and defends regulatory enforcement actions both in court and before the agencies as well as in physician peer review proceedings and related litigation.



Representative Matters

  • Defeated arbitration claims by a durable medical equipment supplier against a Medicaid managed care plan and obtained judgment for damages and attorney’s fees on the plan’s counterclaim based on the supplier’s fraud.
  • Secured judgment for a Medicare Advantage plan of a bad faith lawsuit brought by a plan member because the member had not exhausted administrative remedies and because the claims were preempted by the Medicare Act.
  • Obtained reinstatement of a specialty pharmacy following an appeal of the pharmacy’s disenrollment by the state Medicaid agency.    
  • Won additional reimbursement for a Medicaid managed care plan dispute with a state Medicaid agency concerning the actuarial soundness of capitation payments made by the agency.
  • Represented a health plan in an arbitration by a group of hospitals alleging the plan systemically underpaid thousands of hospital claims worth tens of millions of dollars and established through sampling and audit work that the claims were grossly overstated, resulting in a favorable settlement.


Insights


Speeches & Presentations

  • "Recent Shifts and Lessons Learned in DOJ False Claims Act Enforcement," Los Angeles County Bar Association, Los Angeles, CA (January 9, 2019). Presenters: William S.W. Chang and Peter Roan.
  • "Where is All of the Expected Enrollee and Provider Litigation from the Affordable Care Act?" Blue National Summit, Phoenix, AZ (April 20, 2015). Presenter: Peter Roan.
  • "Hot Issues in Payor/Provider Litigation," Crowell & Moring's Healthcare Ounce Of Prevention Seminar (HOOPS), Washington, D.C. (October 27-28, 2014). Presenters: Chris Flynn and Peter Roan.
  • "Narrow Networks – Now or Never," Blue National Summit, Orlando, FL (May 19, 2014). Peter Roan and Christine M. Clements.
  • "Narrow Networks – Now or Never," Crowell & Moring's Healthcare Ounce Of Prevention Seminar (HOOPS), Los Angeles, CA (May 13, 2014). Presenters: Kevin B. Kroeker and Peter Roan.
  • "Coordinated Care Initiative: Are We Really Ready?" Crowell & Moring's Healthcare Ounce Of Prevention Seminar (HOOPS), Los Angeles, CA (May 13, 2014). Presenters: Peter Roan, Ryan A. Oliver, and Marisa E. Adelson.
  • "Litigation Update," California Association of Health Plans, Legal and Regulatory Affairs Meeting, San Francisco, CA (April 24, 2014). Presenter: Peter Roan.
  • Plan-Provider Managed Care Contracting Webinar Mini-Series: Current Compensation/Reimbursement Issues in Plan Provider Contracting," American Health Lawyers Association Webinar (January 9, 2014). Presenter: Peter Roan.
  • "Litigation Issues Affecting Health Plans in 2012," California Association of Health Plans Annual Meeting (October 15-17, 2012). Presenter: Peter Roan.
  • "Current Legal Issues in Managed Care," Health Care Financial Management Association Fall Conference (September 2009). Presenter: Peter Roan.
  • "Practical Advice on Balance Billing and Payments to Non-Contracted Providers," Western Claims Conference (June 2009). Presenter: Peter Roan.
  • "Provider Contract Rejection: Precipitous Strategy or a Growing Threat to Healthplans?" California Association of Health Plans Annual Meeting (October 2008). Presenter: Peter Roan.
  • "Practical Advice for Payments to Non-Contracted Providers" American Health Lawyers Association Annual Meeting (June 2006). Presenter: Peter Roan.
  • "2005 Managed Care Liability Developments," California Association of Health Plans (October 2005). Presenter: Peter Roan.
  • "Hot Topics for 2005 - Payors, Providers and the Courts: State and Federal Litigation Trends," AHLA Law Conference for Health Plans, Providers, and Insurers (May 2005). Presenter: Peter Roan.
  • "The Supreme Court Speaks on ERISA Preemption of State Law Claims for Wrongful Denial of Healthcare Benefits," AHLA Member Briefing (July 2004). Presenter: Peter Roan.
  • "Recent Issues and Developments in Managed Care," California Society for Healthcare Attorneys Annual Meeting (April 2009). Presenter: Peter Roan.


Publications



Client Alerts & Newsletters



Firm News & Announcements

January 13, 2015 Crowell & Moring Releases Third Annual Litigation Forecast Report and Inaugural Regulatory Forecast
May 27, 2014 Crowell & Moring's Insurance/Reinsurance Group Nominated for Chambers USA "Award of Excellence"
October 9, 2012 Crowell & Moring Strengthens National Health Care Practice with West Coast Partner Trio