Gregory N. Pimstone

Gregory N. Pimstone, a partner at Manatt, Phelps & Phillips, LLP, is a distinguished trial and appellate lawyer specializing in representing California's largest health care entities. With a career spanning three decades, Pimstone has achieved a series of precedent-setting published decisions, contributing significantly to the legal landscape in health care.

His work is characterized by tackling complex, often first-of-their-kind legal issues, including most recently in the realms of health care taxation and provider-payor disputes.

Pimstone successfully represented Blue Shield, defending against an attempt to reclassify managed care health plans as insurance and change their taxation.

This case posed a significant threat to Medi-Cal's funding and could have resulted in substantial back taxes for health plans. The appellate court's affirmation of Blue Shield's victory established a critical precedent regarding the taxation of managed care plans.

"Managed care plans are not viewed as insurance and are not taxed like insurers, which are subject to the Gross Premium Tax," Pimstone said. "Managed care plans are viewed as providing services, not insurance, and are taxed through the Managed Care Organization tax, which funds the state's Medi-Cal system. Had the plaintiff succeeded, the case would have changed how HMOs are viewed under the law, threatened the state's Medi-Cal program and exposed all HMOs in the state to billions in back taxes."

In another notable case, Pimstone led the defense for in a two-month trial brought by a group of substance use disorder clinics against a major California health plan. The case raised essential legal and public policy questions around health care provider offerings to attract patients. The jury found in favor of the plan, awarding significant damages and affirming the plan's counterclaims of fraud, contract interference, and RICO violations.

Sharing insight, Pimstone said there seems to be almost endless litigation between payors and providers regarding the reasonable value of out-of-network emergency services, where the payors and providers have no contract that sets the rates.

"These cases often involve thousands of claims and large differences between what the plans have paid and what the providers believe their services are worth," he said. "In my view, the legislature should step in and establish reasonable rates for non-contracted emergency services, such as mandating payment at an average contracted rate or some multiple of what Medicare would pay for the same services."