Industry

Health Plans

Comprehensive Counsel for Health Plans Nationwide

Sheppard provides end-to-end counsel for health plans, from formation and state licensing to ongoing compliance, strategic growth, transactions and orderly wind-downs when needed.

Our team offers strong federal program expertise, including Medicare Advantage, Medicaid managed care, Medicare Part D and Affordable Care Act compliance. 

Coordinated Support for Complex Health Plan Needs

Sheppard advises every type of health plan, from regional and provider-sponsored plans to national payors, throughout the full lifecycle of plan operations.

Our experienced team guides clients on strategic transactions, licensing, compliance, contracting, benefits management, network development, government program participation, data governance and emerging care models. With our strategic counsel, health plans diversify revenue streams, develop scalable operations and remain agile in a complex regulatory environment. 

As a nationally recognized leader in health plan mergers, acquisitions, joint ventures and value-based care arrangements, we lead complex transactions with efficiency and certainty, guided by a regulatory strategy developed jointly with our clients and educated by our unparalleled experience. We have completed over 110 health plan transactions in the last decade involving commercial, Medicare, Medicaid and specialty products, ranging from major non-profit affiliations to strategic and private equity partnerships, to transactions involving regional and provider-sponsored plans. We have particular strength in representing Blue Cross/Blue Shield Plans, having represented more than 20 Blue Plans in transformational strategic transactions. 

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Areas of Focus

Strategic Transactions
We partner with clients to lead and close healthcare transactions with speed, certainty and a comprehensive understanding of all related business and regulatory issues. Named a Top 10 healthcare M&A firm by Healthcare M&A News in 2025, we have completed more than 120 health plan affiliations, 140 hospital M&A and joint ventures, and dozens of private equity transactions in recent years for clients ranging from regional hospitals and plans to the largest health systems and private investors in the nation. 
Healthcare Regulatory and Compliance
Our regulatory work spans the full range of managed care and insurance regulations. We counsel on state and federal oversight, Centers for Medicare & Medicaid Services and state agency interaction, product design, provider and vendor contracting market conduct, coverage determinations, utilization management and claims administration. With deep experience in Medicare Advantage, Medicaid, Part D and the ACA, we help clients navigate regulatory complexities swiftly and confidently. We advise plans on risk adjustment, quality programs, audits, marketing compliance and enforcement matters that require practical judgment and responsiveness. Many of our lawyers previously served in government, allowing us to offer clients insight into how agencies interpret and enforce regulatory requirements. 
Healthcare Litigation and Government Enforcement Actions
When the stakes are high, healthcare organizations trust us to protect their interests with bold advocacy and strategic problem-solving. Our team’s decades of courtroom and arbitration experience, combined with deep industry insight, enable us to resolve all types of disputes—from commercial disputes and business torts to regulatory enforcement actions to sensitive employment matters. We relentlessly pursue your goals, delivering creative, practical solutions that safeguard your future.
Healthcare False Claims Act Investigations and Litigation
When government scrutiny intensifies, leading healthcare organizations turn to us for defense in complex False Claims Act (FCA) litigation. With experience in over 100 FCA matters and a team that includes more than a dozen former Assistant U.S. Attorneys, we deliver innovative strategies and proven results. We routinely secure declinations and favorable outcomes in cases involving kickbacks, upcoding, HCC coding, services not rendered, Stark Law and Medicare Part D fraud.
Value-Based and Global Risk Arrangements
Accelerate transformation and capture value while minimizing risk. We are a proven leader regarding value-based arrangements, having completed more downstream global risk projects than any U.S. law firm. With our extensive real-world experience, clients can turn innovation into durable revenue and achieve better population health while minimizing enforcement risk.
Healthcare Real Estate
Sheppard advises health systems, providers and investors on complex healthcare and real estate transactions nationwide. We structure and execute joint ventures, acquisitions, financing (including sale-leasebacks), M&A and developments that navigate Stark, Anti-Kickback, tax and other regulatory constraints. Our integrated healthcare real estate team delivers efficient, compliant and commercially sound solutions that support growth, protect mission and drive long-term value.
Healthcare Antitrust
Supporting one of the largest, fastest-growing multisector Healthcare practices, we represent companies facing federal and state antitrust investigations and litigation. We provide pragmatic and strategic counseling to get transactions cleared and investigations closed quickly by antitrust enforcers. We help healthcare companies complete mergers, joint ventures, provider-network collaborations and other strategic initiatives while reducing antitrust exposure—structuring deals, managing HSR filing obligations and navigating clients through the antitrust review process, including the evolving landscape of state antitrust enforcement regimes.
Data Privacy and Security
Our award-winning healthcare privacy team includes former DHS Deputy GC, HHS/OCR investigator, a data breach book author, a former FBI Special Agent, EU data protection experts, and IAPP certified lawyers. Our team provides end-to-end support for data privacy and cybersecurity needs, from proactive privacy and data security counselling to incident response, regulatory investigations and civil litigation.
Healthcare Private Equity
With unparalleled experience in healthcare, we guide private equity funds and their portfolio companies through transformative investments, strategic acquisitions and innovative joint ventures. Our counsel drives growth and operational excellence, enabling clients to navigate regulatory complexities and capitalize on emerging opportunities in value-based care, physician sector consolidation and cutting-edge healthcare technologies.
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Experience

Representative Matters
  • Advised on an innovative payor-provider alignment transaction to launch a jointly owned Medicare Advantage plan—pairing next-generation care offerings with the provider assuming downstream global risk to align incentives, improve outcomes, and lower costs amid a challenging regulatory and competitive landscape. 
  • Led the multi-faceted, comprehensive enterprise-wide reorganization of a large not-for-profit health plan, modernizing governance and operations and creating a scalable health technology business to commercialize artificial intelligence-enabled pharmacy and technology capabilities through strategic co-founder investments.
  • Served as regulatory counsel in a $350 million acquisition of an Affordable Care Act Exchange and Medicare-related services business, expanding the buyer’s government programs footprint by adding an established line of business, a recognized brand and a statewide provider network. 
  • Helped health plans run and grow Medicare Advantage and Part D programs with fewer surprises and stronger outcomes. We delivered multi-state integrations and contract consolidations after major acquisitions, successfully appealed application denials through administrative review, and supported launches of joint-venture plans and Employer Group Waiver Plan offerings. We also provide day-to-day guidance on bids, Special Needs Plans, marketing, audits, Star Ratings, medical loss ratio, network adequacy, and pharmacy benefit manager contracting. 
  • Aligned a four-hospital system, the state’s largest independent physician group, and a Blue Plan to launch the state’s first Medicare and Medicaid population health risk contract and a commercial accountable care organization—driving $60 million in additional first-year profitability through an HCC‑RAF coding and quality program. 
  • Represented a startup company backed in obtaining its health maintenance organization license to offer Medicare Advantage plans.