Peter Roan

Overview

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.

Career & Education

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University of Iowa, B.B.A., 1982
Marquette University Law School, J.D., 1985
- University of Iowa, B.B.A., 1982
- Marquette University Law School, J.D., 1985
California
- California

Challenging and sometimes overlapping state and federal regulatory requirements conceal litigation traps for the unwary. Our health care regulatory prowess allows us to avoid the traps and exploit opportunities for our clients.

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.