Mary Emma has set a high standard in her profession, raised the bar for volunteer efforts, and given Solomon-wise counsel.
Sr. Margaret Ann Moser, President Emeritus, Ursuline Academy


Mary Emma (Ackels) Karam is a preeminent Dallas healthcare contracting attorney, sought after outside general counsel, and recognized authority in managed care. She has practiced law at Jackson Walker for over 30 years, providing practical advice, strategic solutions, and remarkable results for her clients. Mary Emma’s dedication to client service and her reputation for integrity, tenacity, and collaboration are what set her apart. She emphasizes communication, results, and an uncompromising commitment to achieving her clients’ goals while effectively managing their legal costs. To this end, she is personally engaged in every decision that affects her clients, from selecting a legal team, to overseeing strategy, to reviewing every bill. Her deep level of involvement and attention to detail ensures that her clients receive the highest level of professionalism and value in every matter she handles.

Mary Emma’s practice consists of representing clients on the complex contractual aspects of managed care and the healthcare process. She counsels healthcare clients on strategies to accomplish their objectives in a cost-effective manner and advises corporate clients on healthcare related issues. She also advises employers on employee benefit plan issues and cost-management in their insurance plan and pharmacy benefit strategies.

As the first woman associate to become a partner at Jackson Walker and the mother of 6, Mary Emma knows better than most what it takes to break through barriers while still emphasizing the value of collaboration and communication. She has spent decades developing industry relationships, earning the trust and respect of providers and insurers alike and learning the needs and concerns of every participant in the healthcare industry. She is known for her ability to pick up the phone, assess competing interests, and develop a resolution that feels like a win to everyone involved. Her dedication to building meaningful relationships is further evidenced by her success as a mentor and rainmaker and is why she was chosen as Chair of Jackson Walker’s Statewide Business Development and Marketing Committee.

Mary Emma believes in cultivating an attitude of service, in both her career and in her community. Clients appreciate her dedication to their interests and her pragmatic, implementation-oriented advice. She doesn’t just tell clients what to do, she helps them figure out the best way to do it—developing practical strategies that allow them to accomplish their objectives as expeditiously, effectively, and economically as possible. Combining dedication and good judgment with creative thinking and decades of experience, she is able to offer service-centered, value-added representation to every client she represents.

Practice Experience

Healthcare & Managed Care

Mary Emma’s wide range of experience gives her a unique ability to advise providers on the multiple aspects of the managed care contracting process. In her decades-long healthcare practice, she has negotiated, drafted, and defended contracts in all phases of the healthcare system from creation of the initial admission document to final audit of the claim. Her diverse background in healthcare, corporate transactions, and litigation enables her to provide invaluable assistance in the sale or transfer of healthcare entities and provider networks, as well as advising Accountable Care Organizations (ACOs) and working with integrated delivery systems, clinically integrated networks, narrow networks, and various healthcare models.

When it comes to ensuring that a provider’s claims are paid, Mary Emma has a stellar track record. Whether documents need to be reformed, a process needs to be redesigned, or the plan contract needs to be renegotiated, Mary Emma has the experience, know-how, and relationships with Payors and Plans to see that the proper system is in place for claims to be paid promptly and in full. She is also particularly successful at facilitating reinstatement for terminated providers.

Healthcare & Corporate Consulting

Drawing on over 30 years of practice experience both in and out of the healthcare industry, Mary Emma advises healthcare clients on virtually all business transactions, including contract review, management service agreements (MSOs), employment agreements, shareholder agreements, practice acquisitions, auditing and overpayment issues, as well as entity formation, acquisition, and disposition. She currently represents several hospital systems and works with healthcare entities on strategic planning regarding formation of entities and integrated corporate healthcare systems to meet new healthcare initiatives. She is particularly adept at offering strategic insights that help healthcare organizations position themselves for future ventures.

Mary Emma also advises trusts, banking institutions, developers, and other entities on strategic decisions that involve the healthcare industry and offers consulting in litigation, banking, real estate, and corporate matters involving emerging healthcare issues on state and national levels. Her strong litigation background provides a solid foundation for developing effective solutions that anticipate potential issues before they become problems.

Employee Benefit Plans

In recent years, the employee benefits landscape has changed significantly with the ever-increasing costs of healthcare and other benefits, new initiatives, and changes in employment and benefits law. Not only is the proper interpretation and implementation of Employee Benefit Plans more difficult than ever, controlling the costs involved is crucial to offset the increased costs of the benefits and of compliance. With a broad background in health insurance contracting as well as practical experience in the business of healthcare, Mary Emma offers a keen perspective to employers and human resource departments when it comes to analyzing the various components of their health insurance benefit plans, pharmacy benefit plans, third-party administrator agreements, and brokerage arrangements and developing the strategies that will increase efficiency while ensuring cost-effectiveness. By tightening contract language and evaluating the necessity and efficacy of plan components, Mary Emma is able to stop the often-overlooked leakage of money lurking in many plans.

Outside General Counsel

Several institutions, including the Diocese of Dallas, rely on Mary Emma as their outside general counsel. As outside general counsel and advisor, Mary Emma personally selects legal teams and oversees all manner of legal work for her clients with an eye toward maximizing efficiency and minimizing costs. In this facet of her practice, Mary Emma demonstrates her commitment to client service by taking the time to gain a thorough understanding of her clients’ business, providing value-added solutions, and personally ensuring that the clients’ legal needs are met.

Litigation Consulting

Mary Emma began her career in litigation and quickly distinguished herself as a skilled trial lawyer. In 12 years as a litigator, trying at least one case every year, she never lost a jury trial. Drawing upon her strong litigation background, Mary Emma now consults in litigation matters that involve a variety of healthcare and insurance issues and advises banking and corporate institutions in disputes involving healthcare matters.

Career Highlights


Appointed by the Texas Attorney General to serve a term as Special Outside Counsel to the Office of the Attorney General for the State of Texas for consultation in healthcare and managed care matters for the state (2000 – 2001)

Representative Matters

  • Handled managed care contracting for hospital system across 47 states
  • Secured the reinstatement of hospital system terminated by major plan avoiding a loss of over $300 million in revenue without having a break in the contract
  • Secured the reinstatement of physicians’ group terminated by a major plan avoiding a loss of $40 million in revenue without having a break in the contract
  • Resolved $14 million claim dispute in favor of provider based on request for recoupment by major plan for which provider paid nothing
  • Procured favorable resolution of numerous contract disputes for recoupment and overpayment on behalf of providers without litigation or affecting in-network status
  • Develops unique strategies to preserve capital and enhance revenue for public hospitals and hospital districts
  • Coordinates legal work for companies using efficiency in staffing and advising on corporate legal strategy
  • Negotiates contracts for Employee Benefit Plans at significant cost-savings to plan without changing benefits provided or vendors
  • Negotiates employer contracts with the brokers, TPAs, insurers, and vendors
  • Acts as outside General Counsel to the Roman Catholic Diocese of Dallas overseeing selection of legal teams as needed and necessary legal work to effectuate the business, real estate, and employment needs of the Diocese
  • Early in career, represented Texas Utilities in nuclear power plant litigation matters for several years including managing the coordination of a large number of attorneys, engineers, and other professionals; briefing and argument of numerous legal issues; and handling the organization, review, production, and maintenance of more than 40 million pages of documents
  • Regularly advises on litigation and oversees litigation strategies


  • The American Health Lawyers Association, Member
  • Attorneys Serving the Community, Member
  • Children’s Medical Center of Dallas, Honorary Co-chair – Six Flags over Texas Fundraising Event, 2006
  • Dallas Bar Association – Health Law Section
  • State Bar of Texas – Health Law Section
  • Texas Bar Association, Pro Bono College, 2013-2016
  • Joseph’s Residence, Counsel to the Board, 2014-present
  • Jude Children’s Research Hospital, Former Host Committee Member
  • Ursuline Academy
    • Past President and Past Member of Board of Trustees
    • Past Chairman and Past President of Ursuline Academy Foundation


Mary Emma is a regular speaker on healthcare issues and client service in the legal field. A few representative examples of her speaking engagements include the following:

  • “How to Seek and Serve Your Clients – Business Development Tips with an Emphasis on Women Attorneys,” Dallas Association of Young Lawyers (DAYL), DAYL Moms in Law Group, and Dallas Women Lawyers Association Luncheon, August 2017
  • “Increasing Transparency to Control Costs in Health Benefit Plan Contracts,” National Health Benefits Conference & Expo (HBCE), February 2017
  • “Top Five Changes to Make to Your Employer Health Benefit Plan to Control Costs,” International Foundation of Employee Benefit Plans, September 2016
  • “Health Plan Checkup: Maintaining a Healthy Relationship with your Broker, Insurer, and Third Party Administrator,” 2015 Labor and Employment Seminar, Westin Hotel, Dallas, Texas, November 2015
  • “What You Should Know About Your Health Benefit Plan and Pharmacy Program,” Healthcare Law Seminar: What Keeps You Up at Night, Dallas Country Club, September 2015
  • “Top Five Changes to Make Your Employer Benefit Plan Contracts,” Member Benefit Plan Roundtable Presentations, Dallas, Texas, 2015
  • “Enhancing the Revenue Cycle: Admission to Audit,” Teaching Hospitals of Texas, October 2014
  • “Update on Affordable Care Organizations: Positioning Your Hospital for the Future of Healthcare,” Teaching Hospitals of Texas, October 2014
  • “Building Business Relationships and Work/Life Balance,” GameStop Women’s Leadership Conference, September 2014
  • “Secrets of Managed Care and Questions about Accountable Care Organizations,” Teaching Hospitals of Texas, October 2013
  • “Managed Care Contracting,” National Medical Group Management Association Annual Conference, Las Vegas, Nevada, Fall 2011
  • “Accountable Care Organizations (ACOs): Blueprint for Success,” North Texas American College of Healthcare Executives, panel presentation, May 2011
  • “Understanding Key Legal Provisions and Impact of ERISA,” 2010 Fall Managed Care Forum for the National Association of Managed Care Physicians, Winter 2010

News & Events

  • Attorney News

    Texas Bar Foundation Elects Ten Jackson Walker Attorneys to Fellowship

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  • Attorney News

    Mary Emma Karam Speaks on Business Development for Women Attorneys

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  • Spotlight

    Texas Lawyer Honors Mary Emma Karam and Amanda Zimmerman with 2017 Professional Excellence Awards

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  • Spotlight

    Mary Emma Karam Named in 2016 Top 15 Business Women of Dallas by National Women’s Council, an Initiative of the National Diversity Council

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  • Spotlight

    Mary Emma Karam Featured in Law360’s Rainmaker Q&A Series

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  • Highlights

    New Law Continues to Require Out-of-Network Facility-Based Physicians to Notify Patients of Mediation Rights

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  • Attorney News

    Mary Emma Karam Named AHLA Champion for Second Consecutive Year

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  • Spotlight

    Practical, strategic leadership | Mary Emma Karam

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  • Highlights

    EEOC Proposes Rules Related to Employee Wellness Programs

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  • Highlights

    Recent Federal Court Ruling: No ERISA Preemption of Texas Prompt Pay Law Regarding Payment Deadlines; Texas Legislature May Act on Prompt Pay Issues

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  • Highlights

    Recent Federal Court Ruling on Application of Texas Prompt Pay Laws to Self-Funded, Medicaid and Out-of-State Plans and Their Third Party Administrators

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  • Attorney News

    Mary Emma Karam Named AHLA Champion

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  • Press Releases

    Mary Emma Karam Quoted in ‘The Texas Catholic’

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  • Press Releases

    Mary Emma Karam Participates in KPMG Executive Leadership Institute for Women

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