Peter Roan

, Partner Los Angeles
proan@crowell.com
Phone: +1 213.443.5571
515 South Flower St., 40th Floor
Los Angeles, CA 90071-2201

Peter Roan is a Health Care Group partner in Crowell & Moring’s Los Angeles office. With over 30 years of experience, Peter concentrates his practice on litigation in the health care and insurance industries. He represents managed care organizations, health benefit plans, Medicare Advantage Organizations, Medicaid managed care plans, insurers, plan administrators, 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. Peter’s health care litigation experience includes payer / provider and other disputes and defending class action, 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 payer organizations participating in government sponsored health programs including Medicare Advantage, Medicaid, TRICARE and FEHBP. He also represents clients facing regulatory enforcement action both in court and before the agencies, and in peer review proceedings and follow-on litigation.

Peter received his bachelor’s degree from the University of Iowa and his law degree from Marquette University.

Representative Engagements

  • Successfully secured dismissal of a bad faith lawsuit brought by a Medicare Advantage plan member against a Medicare Advantage Organization because the plan member had not exhausted Medicare administrative remedies and because the claims were preempted by the Medicare Act.
  • Secure dismissals of lawsuits against Medicare Advantage Organizations by non-contracted hospitals because the hospitals claims were subject to the exhaustion requirement.
  • Successfully obtained reinstatement of a specialty pharmacy following an appeal of the pharmacy’s disenrollment by the state Medicaid agency.     
  • Defeated arbitration claims by 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.  
  • Successfully represented Medicaid managed care plan in dispute concerning the actuarial soundness of payments made by the state Medicaid agency.  
  • Represented workers compensation insurers and administrators in a federal court RICO and antitrust action brought by a business that provided management and billing services to physicians that dispensed prescription medications to workers compensation patients; the antitrust case was dismissed on motions resulting in a settlement. 
  • Defeated class certification in a consumer class action alleging that the client health plan systemically violated laws requiring coverage of reconstructive surgery. 
  • Secured dismissal of a lawsuit brought by a provider of air ambulance services against over 80 insurers and public and private employers alleging that the Airline Deregulation Act preempted state laws that created the payment rate for air ambulance services. 
  • Successfully represented a managed care organization in an arbitration alleging the organization 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. 
  • Represented a health plan in binding arbitration brought by several hospitals that asserted the plan had systemically underpaid them for services provided to the plan's members under numerous separate contracts covering all plan types; the case was settled following arbitration hearings. 
  • Represented a health plan in actions brought by emergency service providers who contended that the plan was required to pay billed charges when the plan’s contracted physician group that accepted financial risk for emergency services from the plan failed to pay; the trial court dismissed the claims which were upheld on appeal. 
  • Recovered $8 million in overpayments for a health plan following binding arbitration commenced against a hospital that refused to return the overpayments based on numerous legal and factual grounds. 
  • Represented a trade association in a federal court challenge to state laws and regulations that the client asserted were preempted under Medicare laws resulting in a permanent injunction against the enforcement of over 100 state laws and regulations.

Affiliations

Admitted to practice: California



Highlights, News & Knowledge

Speeches & Presentations

  • "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

Jan.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"
Oct.09.2012 Crowell & Moring Strengthens National Health Care Practice with West Coast Partner Trio