Ima E. Nsien focuses her practice on healthcare litigation and arbitration. Ima has experience litigating a variety of complex disputes, including issues involving federal mental health parity, breach of health plan contract in connection with medical necessity determinations, contracted and non-participating provider reimbursement, Section 17200 unfair competition, bad faith denial or delay of benefits, HMO negligence, and wrongful denial of benefits under ERISA. Ima also has experience handling skilled nursing facility enforcement action appeals before state and federal regulators. She has represented some of the largest payers and providers within the healthcare industry, including health plans and insurers, hospitals and nursing facilities, as well as pharmaceutical companies.

Ima also assists health plans with formation and licensure under the Knox-Keene Act, counsels healthcare clients participating in government programs such as Medicaid and Medicare on reimbursement and appeals, and represents healthcare clients in government investigations. She proactively advises clients on maintaining compliance with state and federal regulations to minimize the risk of costly litigation. However, if litigation is unavoidable, Ima utilizes her years of experience to provide unique insights and strategies that are tailored to the specific needs of her clients.

Ima also served as a judicial law clerk for the Superior Court of California after graduating from the University of Texas School of Law.

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Litigation and Arbitration Matters

  • Secured dismissal of a federal mental health parity claim against an employee welfare benefit plan regarding coverage of residential treatment.
  • Represented a skilled nursing facility through a bench trial in an enforcement action appeal against the California Department of Public Health.
  • Obtained a summary judgment on behalf of a large health plan in a wrongful death dispute valued at US$5 million in damages.
  • Assisted a pharmaceutical company in responding to a civil investigative demand in a False Claims Act antitrust dispute.
  • Represented a skilled nursing facility in an administrative enforcement action before the US Department of Health & Human Services Departmental Appeals Board.
  • Negotiated a favorable settlement on behalf of a large health plan in a bad faith denial of benefits dispute.
  • Defended a hospital in a class action against emergency medical services providers.
  • Represented a managed Medi-Cal plan in arbitration against 14 hospitals alleging underpayment.
  • Represented a large health plan in mediation involving medical necessity determination for investigational treatment.
  • Represented a health plan in a quantum meruit dispute against an out of network medical provider.

Regulatory Compliance Matters

  • Advised a client on California Department of Managed Healthcare (DMHC) regulations regarding the formation and licensure of Medicare Advantage healthcare service plans, including review of:
    • Anti-fraud plans
    • Administrative and management services contracts
    • Pharmacy benefit management services agreements
    • Hospital services agreements
    • Provider contracts
    • Risk sharing agreements
  • Represented an employee assistance program client in a pre-licensing conference before the DMHC regarding Knox-Keene Act exemption.
  • Advised a client on the Medicare prescription drug coverage appeals process.
  • Advised a large health insurer on laws governing the collection of racial data to support social determinants of healthcare and health equity initiatives.
  • Advised a client on the physician assistant and nurse practitioner scope of practice laws in all states.

Education

  • University of Texas School of Law, J.D., 2014
  • University of Southern California, B.A., magna cum laude, 2010

Admissions

  • California, 2015

Courts

  • U.S. Dist. Ct., N. Dist. of California
  • U.S. Dist. Ct., C. Dist. of California

Memberships and Affiliations

  • Member, American Bar Association (ABA)
    • Health Law Section Diversity and Inclusion Committee
    • Health Law eSource Newsletter Board
  • Member, California Society for Healthcare Attorneys
  • Member, Los Angeles County Bar Association, Health Law Section
  • Member, Board of Directors, Los Angeles Family Housing, Risk Management and Programs Committee
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  • Author, “Recent Changes to the Definition of Sex Discrimination Under Section 1557 of the Patient Protection and Affordable Care Act,” ABA Health eSource, December 2020.
  • Author, “Recent Trends in Health Savings Account Limits,” ABA The Health Lawyer, March 2019.
  • Author, “Law Updates Hospital Discharge Policy for Homeless Patients,” The Daily Journal Los Angeles, February 2019.
  • Author, “Navigating the Federal Regulatory Structure of Assisted Reproduction Technology Clinics,” ABA Health eSource, November 2017.
  • Author, “Exploring the Legal and Ethical Roadblocks to Mitochondrial Replacement Technique Human Clinical Trials,” ABA Health eSource, April 2017.

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