Overview

Health care industry clients (including local health plans, managed care organizations, and other risk-bearing entities) look to attorney James Reilly to help them stay compliant with evolving legal and regulatory requirements and for advice on a wide range of complex business issues.

In addition to his work with managed care entities, James advises providers of all sizes—ranging from start-up health companies and Federally Qualified Health Centers to large multistate medical groups—on legal and strategic matters involving corporate formation, licensing, and contractual arrangements. Provider organizations rely on his experience with managed care organizations and government regulators to develop successful strategies for market entry and growth.

Clients also seek James’s counsel on administrative law issues relating to enforcement and licensing by regulatory bodies.

James began his career working at several health care service plans in California, where he gained firsthand insight into the complexities of their day-to-day operations and compliance challenges. This real-world experience provides him with a distinctive perspective that informs his ability to develop practical and innovative solutions, as well as navigate intricate regulatory frameworks.

Before joining Epstein Becker Green, James was a health care attorney at a national law firm. While studying law, James worked in the UC Hastings Legal Clinic, participating in administrative hearings and conducting extensive medical record reviews to ensure clients could get Social Security disability benefits. 

Experience

  • Serves as general counsel for a local health plan with responsibility for managed care and government program matters.
  • Serves as outside counsel to regional and national health insurers, managed care companies, and providers on compliance with:
    • state Medicaid and Medicare regulators,
    • the Medicare Advantage program,
    • corporate practice of medicine, and
    • fraud, waste, and abuse laws.
  • Serves as outside counsel to managed care organizations in disputes with various regulatory agencies over issues ranging from rate disputes to contract breaches.
  • Serves as outside counsel to provider organizations looking to obtain and maintain licensure to provide care in the Medicaid and Medicare spaces as facilities or provider groups.

Focus Areas

Credentials

Education

  • UC College of the Law, San Francisco (J.D.)
    • Concentration in Health Law and Policy
    • Editor, UC Law SF Communication and Entertainment Law Journal
  • University of California, Santa Barbara (B.A.)

Bar Admissions

Insights

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