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
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"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.
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"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.
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"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.
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"Narrow Networks – Now or Never," Blue National Summit, Orlando, FL
(May 19, 2014).
Peter Roan and Christine M. Clements.
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"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.
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"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.
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"Litigation Update," California Association of Health Plans, Legal and Regulatory Affairs Meeting, San Francisco, CA
(April 24, 2014).
Presenter: Peter Roan.
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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.
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"Litigation Issues Affecting Health Plans in 2012," California Association of Health Plans Annual Meeting
(October 15-17, 2012).
Presenter: Peter Roan.
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"Current Legal Issues in Managed Care," Health Care Financial Management Association Fall Conference
(September 2009).
Presenter: Peter Roan.
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"Practical Advice on Balance Billing and Payments to Non-Contracted Providers," Western Claims Conference
(June 2009).
Presenter: Peter Roan.
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"Provider Contract Rejection: Precipitous Strategy or a Growing Threat to Healthplans?" California Association of Health Plans Annual Meeting
(October 2008).
Presenter: Peter Roan.
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"Practical Advice for Payments to Non-Contracted Providers" American Health Lawyers Association Annual Meeting
(June 2006).
Presenter: Peter Roan.
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"2005 Managed Care Liability Developments," California Association of Health Plans
(October 2005).
Presenter: Peter Roan.
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"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.
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"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.
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"Recent Issues and Developments in Managed Care," California Society for Healthcare Attorneys Annual Meeting
(April 2009).
Presenter: Peter Roan.
Publications
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"California Supreme Court Prohibits Waiver of Public Injunctive Relief in Arbitration Agreements," Crowell & Moring's Health Law Blog
(April 12, 2017).
Authors: Peter Roan, Harsh P. Parikh and Jesse C. Martin.
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"Ninth Circuit Bars Providers from Enforcing ERISA Protections on ERISA Plan Administrators," American Health Lawyers Association Payers, Plans, and Managed Care Newsletter
(April 7, 2017).
Authors: Harsh P. Parikh and Peter Roan.
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"New California Law To Target Surprise Bills Impacts Payor Relationships With Non-Contracted Professionals," Crowell & Moring's Health Law Blog
(October 18, 2016).
Authors: Harsh P. Parikh and Peter Roan.
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"CMS Proposes Significant Changes Impacting Medicare Appeals Processes," American Health Lawyers Association Payers, Plans, and Managed Care Newsletter
(July 18, 2016).
Authors: Peter Roan and Harsh P. Parikh.
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"Sequestration Extended to 2025 in Federal Budget Deal," Crowell & Moring's Health Law Blog
(December 10, 2015).
Authors: Christopher Flynn, Peter Roan, Michael W. Lieberman, and Harsh P. Parikh.
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"CMS Proposes To Modify 'Two-Midnight Benchmark' To Broaden Exceptions for Part A Payments for Short Inpatient Stays," Crowell & Moring's Health Law Blog
(July 16, 2015).
Authors: Harsh P. Parikh, Troy A. Barsky, and Peter Roan.
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"What Insurers Should Know About Emergency Regulations from the California Dept. of Insurance," Crowell & Moring's Health Law Blog
(February 4, 2015).
Co-Authors: Harsh P. Parikh and Peter Roan.
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"Litigation Forecast 2015: What Corporate Counsel Need to Know for the Coming Year," a Crowell & Moring LLP publication
(January 2015).
Contributor.
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"CMS Proposed Rule On Affordable Care Act Standards For Essential Health Benefits, Actuarial Value, And Accreditation," Health Lawyers Weekly, Vol. 10, Issue 49
(December 14, 2012).
Co-Authors: Kevin B. Kroeker and Peter Roan.
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"Affirming the Right to Rescind In California," Law360
(February 1, 2010).
Author: Peter Roan.
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"Application of Medical Billing Standards to Claims Submitted by Non-Contracted Providers" AHLA HMOs and Health Plans Practice Group, Vol. 11, Issue 1
(February 2008).
Co-Authors: Peter Roan and Ronald Kurtz.
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"Transfer of Financial Risk by HMOs to Health Care Providers: May HMOs Escape Liability When Their Contractors Fail to Pay?" 9 BNA Health Plan & Provider Report Rep. 1137
(October 1, 2003).
Co-Authors: Peter Roan and Joshua Mandell.
Client Alerts & Newsletters
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"Supreme Court Clarifies that the Arbitrator, and Not the Court, Determines when Arbitration Is Required Under the Federal Arbitration Act,"
Health Care Alert
(January 10, 2019).
Contact: Peter Roan
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"Managed Care Lawsuit Watch - September 2017,"
Managed Care Lawsuit Watch
(September 6, 2017).
Contacts: Christopher Flynn, Peter Roan
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"Managed Care Lawsuit Watch - February 2017,"
Managed Care Lawsuit Watch
(February 2, 2017).
Contacts: Christopher Flynn, Peter Roan, Brian C. Lewis, Rochelle-Leigh Rosenberg, Lauren R. Nunez
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"New California Law to Curb Surprise Medical Bills Will Impact Relationships Between Health Plans and Non-Contracted Professionals,"
Health Care Alert
(October 18, 2016).
Contact: Peter Roan
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"Managed Care Lawsuit Watch - August 2016,"
Managed Care Lawsuit Watch
(September 6, 2016).
Contacts: Christopher Flynn, Peter Roan, Lauren R. Nunez, Rochelle-Leigh Rosenberg, Joe Records, Brian C. Lewis
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"Managed Care Lawsuit Watch - March 2016,"
Managed Care Lawsuit Watch
(March 29, 2016).
Contacts: Christopher Flynn, Peter Roan, Roma Sharma, Rochelle-Leigh Rosenberg, Brian C. Lewis, Lauren R. Nunez
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"Managed Care Lawsuit Watch - November 2015,"
Managed Care Lawsuit Watch
(November 4, 2015).
Contacts: Joe Records, Christopher Flynn, Peter Roan
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"Managed Care Lawsuit Watch - June 2015,"
Managed Care Lawsuit Watch
(June 8, 2015).
Contacts: Joe Records, Rochelle-Leigh Rosenberg, Christopher Flynn, Peter Roan
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"Managed Care Lawsuit Watch - March 2015,"
Managed Care Lawsuit Watch
(March 5, 2015).
Contacts: Christopher Flynn, Peter Roan
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"California Department of Insurance’s Emergency Regulations on Provider Networks Go Into Effect,"
Health Care Alert
(February 3, 2015).
Contact: Peter Roan
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"California Court of Appeal Expands Coverage for Autism Related Services for Certain Health Plans,"
Health Care Alert
(April 28, 2014).
Contacts: Peter Roan, Christopher Flynn
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"CMS Proposed Rule on Affordable Care Act Standards for Essential Health Benefits, Actuarial Value and Accreditation,"
Health Care Alert
(November 29, 2012).
Contact: Peter Roan
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"Managed Care Lawsuit Watch - December 2006,"
Managed Care Lawsuit Watch
(December 7, 2006).
Contacts: Christopher Flynn, Peter Roan
Firm News & Announcements