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

May 2, 2017 8:45am

James J. McCarrie, II
Aetna (Blue Bell, PA)

Matthew R. Varzally
Senior Counsel-Litigation & Investigations
Humana Inc

Ed Brooks
McGuire Woods LLP (Chicago, IL)

Tracy A. Roman
Crowell & Moring LLP

Greg Scott
Vice Chairman, US Leader, Health Plans

  • 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