8th Annual Advanced Forum on Managed Care Disputes and Litigation

Registration and Continental Breakfast

Co-Chairs’ Welcoming Remarks

Year in Review 2016: Recent Trends and Updates in Managed Care

• Impact of the election on the status of the ACA
• Class actions for prescription co-pays
• Consolidation of hospital systems
  • Understanding red flags and when it becomes an anti-trust problem
  • Negotiating with hospital systems and their exclusive provider groups
  • Best practices for MCOs to protect themselves and their insureds
• Increasing wave of cases involving provider fraud schemes
  • UnitedHealth Group v. American Renal Associates
  • Referrals to out-of-network ambulatory surgery centers when the provider is part owner of the ASC
• Discrimination – 1557
• New trends on the horizon

Morning Refreshment Break

Risk Corridor Litigation: Getting the Best Results from a Bad Situation

• Overview of the risk corridor landscape today
• Examination of the current suits in progress
  • Analyzing whether to move forward with your own suit or hang back and wait
  • Determining the realistic outcomes of this type of suit
  • Understanding when to settle
• What changes to expect under the Trump Administration

Successful Commercial Risk Adjustment Strategies

One of the biggest threats to MCOs under the ACA has been failing to understand commercial Risk Adjustment. In this session, learn about how commercial Risk Adjustment works from one of the policy experts at the company that has had the most success in navigating the Risk Adjustment-driven market. Learn how it changes everything your MCO does, from strategic planning, marketing, product development, member services, provider practices, and what happens when plans fail to adjust to a post-risk adjustment market. Find out what role risk adjustment could play in a post-ACA world.

Spotlight on Medicare Risk Adjustment

One of the biggest legal and financial threat to Medicare Advantage plans involves allegations of false submissions of risk adjustment data to CMS under Medicare Risk Adjustment. In this session, learn about the regulatory compliance and False Claims Act litigation risks that Medicare Advantage plans face, get an update on the current landscape of regulatory oversight and ongoing qui tam cases, and discuss best practices for ensuring data integrity and minimizing compliance risk.

Networking Lunch

A Day in the Life of In-House Counsel in 2017: The Ever Expanding Wheelhouse of Today’s In-House Litigator

Join a conversation amongst in-house counsel on stage and in the audience to gain first-hand insights into the daily challenges they face, including:

• Struggle of wearing many hats:
  • Litigator
  • PR Guru
  • Risk manager
• While also considering:
  • Budgets
  • Staffing
  • Reporting demands

Afternoon Networking Break

Deep-Dive into Healthcare False Claims: Analysis of Current Trends in False Claims Cases for MCOs

• Qui Tam cases against MCOs
  • Establishing plans to avoid Qui Tam cases against your MCO
  • Discerning and avoiding the most Common pitfalls
  • Developing methods to win the case
• Qui Tam Cases against providers
  • Responsibilities of MCOs to report potential provider fraud, if any
• Identifying your role in provider Qui Tam cases

The Future of Provider vs. Payor Disputes

• Lawsuits with out-of-network providers and the confusion over contracts
• Disputes between MCOs and third party payors
• Hospital suits against MCOs
  • Handling suits from hospitals who believe they were underpaid
  • Fights over emergency room payments
  • Handling improper overnight stays and other types of overbilling
• Emerging trend of health plans being the plaintiff rather than the defendant

Conference Adjourns to Day Two

Registration and Continental Breakfast

Co-Chairs’ Welcoming Remarks

Antitrust Cases: How to Adjust Your Business Model in the Wake of the Anthem/Cigna and Humana/Aetna Decisions

2016 brought the Managed Care industry two of the most impactful Antitrust cases in recent history. Our distinguished panel with insider knowledge will help you unbox these decisions and interpret the lasting effect they will have on your providers, MCOs, and the market as a whole.

2017: The Year of Change for Medicare and Medicaid

• Review of the final Medicaid rules going into effect this year
  • Find out how other MCOs are adapting to meet these requirements
• Medicare/Medicaid litigation and enforcement risks
  • Identifying potential risks of Medicare and Medicaid plans
  • Identifying potential risks of Medicare and Medicaid plans
  • Weighing these risks against the prospective benefits for your company
• Understanding the Trump Administration’s effect on the Medicare Program
• How will Trump’s changes to the ACA affect Medicaid
  • Analyzing the fate of state expansion programs
  • Addressing the potential federal changes and their impact on MCOs

Morning Networking Refreshment Break

Cybersecurity and Service Providers: Strategies for Keeping Compliant when Dealing with Outside Vendors

• Analysis of New State and Federal Information Security Regulations
• Vendor Management Best Practices
  • Developing information security plans to keep information protected when you have little oversight
  • Explaining HIPAA to third parties who handle your information

Conference Adjourns Lunch for workshop attendees only