Day 1 - Thursday, May 16, 2019

7:30
Continental Breakfast
8:15
Co-Chairs’ Welcoming Remarks
8:30
Townhall on New Developments in the Managed Care Industry
9:15

IN-HOUSE COUNSEL THINK-TANK

The Challenges of Being a Managed Care Entity in Today’s Healthcare Environment
10:15
Morning Coffee Break
10:30
Developing Successful Strategies for Handling Payor vs. Non-Par Provider Reimbursement Disputes
11:45
Addressing Disputes among Contracted Providers and Payors
12:30
Networking Luncheon
1:30
Coverage Considerations for New Trends in Behavioral Therapy
2:30
Assessing the Impact of the Medicaid Work Requirement on Managed Care Organizations
3:15
Afternoon Networking Break
3:45
Medicare Risk Adjustment: Understanding the Implications of the Latest Enforcement and Litigation Developments
4:30
Understanding How Future Developments with the Affordable Care Act Will Impact Managed Care Organizations
5:15
Conference Adjourns to Day Two

Day 2 - Friday, May 17, 2019

7:45
Continental Breakfast
8:15
Co-Chairs’ Remarks and Recap of Day One
8:30

FOCUS ON FCA/QUI TAM AND CLASS ACTION ACTIVITY

What Lies Ahead for Managed Care Organizations with Respect to Opioid Litigation
9:15

FOCUS ON FCA/QUI TAM AND CLASS ACTION ACTIVITY

False Claims Act and Enforcement Activity Affecting MCOs
10:15
Morning Coffee Break
10:30
Examining New Class Action Activity in the Managed Care Space
11:15
A Practical Guide for Assessing and Responding to Potential Data Breach
12:15
Networking Luncheon
1:15
Spotlight on Antitrust: Disputes and Investigations Involving Contracting Practices Between Providers and Payors in Managed Care
2:15
What Do Payors Need to Be Aware of with Respect to PBM Litigation
3:00
Conference Ends

Day 1 - Thursday, May 16, 2019

7:30
Continental Breakfast
8:15
Co-Chairs’ Welcoming Remarks

Archana R. Rajendra
Associate General Counsel
CareSource

Thomas Vecchio
Senior Managing Counsel - Federal Regulatory
Cigna (Philadelphia, PA)

8:30
Townhall on New Developments in the Managed Care Industry

Kari Bomash
Associate General Counsel, Law Department
Medica Health Plans (Saint Paul, MN)

Kirstin B. Ives
Partner and Chair of Healthcare Litigation Practice
Falkenberg Ives LLP (Chicago, IL)

Having a holistic view of the industry is crucial in determining litigation strategies. This session will provide a review of current cutting-edge developments and policies impacting the managed care industry. Topics of discussion will include:

  • Navigating the new playing field: new CMS directives with respect to social determinants
    • Exploring the renewed focus on adding benefits for GED, housing, and other long-term support services under Medicaid
    • DNA of a zip code
  • Developing strategies for mitigating the medical director exposure
    • Best practices for risk management in terms of D&O and E&O policies
  • Analyzing effective ways of addressing medical necessity treatments

9:15

IN-HOUSE COUNSEL THINK-TANK

The Challenges of Being a Managed Care Entity in Today’s Healthcare Environment

Sara Anthony
Senior Associate General Counsel
Blue Cross and Blue Shield of Kansas City (Kansas City, MO)

Elizabeth Monohan
Assistant General Counsel
Humana (Louisville, KY)

Lou Patalano
Vice President & Deputy General Counsel
BCBSNC (Durham, NC)

  • Addressing coverage and cost challenges in the current environment
    • How to expand coverage and keep premiums low
  • Examining the Medicare/Medicaid expansion in various states and potential impact on payors
  • Exploring the impact of new entrants (e.g., Amazon, Berkshire) on payors
  • Analyzing HHS’ guidance on how to implement its blueprint for drug pricing
    • How do MCOs anticipate the drug pricing developments will impact existing contractual arrangements? What types of risk will MCOs potentially be exposed to?
  • Exploring the recent trend of moving discovery in-house
    • Do in-house counsel feel they are equipped to handle the bulk of the discovery matters in-house?

10:15
Morning Coffee Break
10:30
Developing Successful Strategies for Handling Payor vs. Non-Par Provider Reimbursement Disputes

Mark Abernathy
Managing Director
Berkeley Research Group (Tampa, FL)

Jessica Chapman
Litigation Counsel
Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)

John T. Fogarty
Partner
Manatt, Phelps & Phillips, LLP (Los Angeles, CA)

Matthew A. Heinle
General Counsel
Mercy Medical Center (Canton, OH)

Jason Daniel Joffe
Partner
Squire Patton Boggs (US) LLP (Miami/West Palm Beach, FL)

Disputes with non-par providers in both the emergency and nonemergency context are perhaps one of the greatest challenges that the managed care industry is presently facing. This session will help you address these disputes in both the emergency and nonemergency context.   Emergency context

  • Exploring the “greater of three” and typical disputes in this arena
  • Devising best practices for handling claims brought by out of network providers indicating that they were promised a particular preauthorization rate Developing defense strategies for disputes with non-contracted hospital(s) or medical group
    • What comes up in these cases?
    • What is the focus when determining reasonable value?
    • What expert testimony is needed?
    • What evidence is necessary?
  • Exploring defenses against arguments put forth by providers including:
    • The provider had to treat because it was an emergency situation
    • Various state statutes and ACA demand that a provider treats in emergency situations
  Non-emergency context
  • Addressing customer service representations regarding coverages
    • Developing best practices for handling communications with providers during preauthorization process
    • Suggested ways for MCOs to train and monitor how their customer service addresses pre-authorizations and reimbursement discussions

11:45
Addressing Disputes among Contracted Providers and Payors

Rania M. Basha
Senior Legal Counsel
Humana (Louisville, KY)

Michael W. Lieberman
Partner
Crowell & Moring (Washington, DC)

Jon Rose
Senior Litigation Counsel
HCA (Nashville, TN)

  • As payment methodology moves toward “pay-for-performance” type of an arrangement, how can payments to providers be determined without it turning into a litigation issue?
    • How to reimburse individual providers and have enough transparency where providers believe that it is fair and complying with the contract
    • If there can be no transparency, what are the strategies for most efficient resolution of these disputes?
  • Best strategies for handling disputes in an arbitration context

12:30
Networking Luncheon
1:30
Coverage Considerations for New Trends in Behavioral Therapy

Cavender C. (“Chris”) Kimble
Partner
Balch & Bingham LLP (Birmingham, AL)

Jonathan M. Herman
Managing Member
Herman Law Firm (Dallas, TX)

  • Addressing disputes between payors and providers involving behavioral therapies for various conditions (e.g., autism, substance use disorder (SUD), and various psychiatric conditions)
    • Developing best strategies for resolving reimbursement disputes where provider continued treatment beyond what was necessary
  • Exploring the new trend involving “wilderness therapy” and the controversy over its coverage
  • Analyzing litigation trends and best practices relative to these new therapies

2:30
Assessing the Impact of the Medicaid Work Requirement on Managed Care Organizations

Ashlee M. Knuckey
Partner
Locke Lord LLP (Chicago, IL)

Archana R. Rajendra
Associate General Counsel
CareSource

  • Examining individual state work requirements
  • What are the operational challenges for MCOs under the work requirement?
    • Tracking eligibility
    • Documentation
  • Exploring the status of any current litigation

3:15
Afternoon Networking Break
3:45
Medicare Risk Adjustment: Understanding the Implications of the Latest Enforcement and Litigation Developments

Jason E. Christ
Member
Epstein Becker and Green (Washington, DC)

Julie Nielsen
Managing Director
Berkeley Research Group (Tampa, FL)

  • Exploring the latest evolution of the regulatory and enforcement landscape in Medicare Risk Adjustment
  • Developing best practices and proactive strategies for Medicare Advantage plans to protect against litigation in light of shifting government positions and lack of guidance
  • Discussing methods for conducting thoughtful and effective internal investigations protected by attorney-client privilege

4:30
Understanding How Future Developments with the Affordable Care Act Will Impact Managed Care Organizations

Ursula A. Taylor
Member
Strategic Health Law (Chicago, IL)

Thomas Vecchio
Senior Managing Counsel - Federal Regulatory
Cigna (Philadelphia, PA)

  • Examining the latest lawsuits and decisions challenging the Act’s constitutionality
  • Assessing the potential consequences of the repeal or defunding of the Act by Congress
  • Developing strategies for moving forward in the face of legislative uncertainty

5:15
Conference Adjourns to Day Two

Day 2 - Friday, May 17, 2019

7:45
Continental Breakfast
8:15
Co-Chairs’ Remarks and Recap of Day One
8:30

FOCUS ON FCA/QUI TAM AND CLASS ACTION ACTIVITY

What Lies Ahead for Managed Care Organizations with Respect to Opioid Litigation

Michael P. Abate
Partner
Kaplan Johnson Abate & Bird LLP (Louisville, KY)

Amanda L. Waesch
Partner
Brennan, Manna & Diamond (Akron, OH)

  • Addressing theories of liability implicating managed care organizations in the current opiod litigation
  • Risk management perspective: how are MCOs handling opioid procedures internally?
  • Addressing treatment for addiction not typically covered: How have plans evolved, if at all, as a result of the epidemic?
    • What changes are plans seeing in their policies in relation to opioid therapies and treatments?
  • Exploring the interest in recouping funds from prescribers who are overprescribing
  • Examining the possibility and probability of suing opioid manufacturers
    • Examining potential affirmative claims health plans would be bringing against manufacturers, distributors, and providers

9:15

FOCUS ON FCA/QUI TAM AND CLASS ACTION ACTIVITY

False Claims Act and Enforcement Activity Affecting MCOs

Norman Beck
Divisional Vice President, Senior Litigation Counsel
Blue Cross and Blue Shield of Illinois (Chicago, IL)

Colin R. Jennings
Partner
Squire Patton Boggs (Cleveland, OH)

  • Exploring recent FCA/qui tam activity in the managed care realm
  • What are the new areas of enforcement?
  • What are the key theories as to how to defeat these claims?
  • Examining the anticipated trend of plans suing as plaintiffs under FCA
    • Determining when to pursue affirmative cost recovery litigation against third parties
    • Examining successful claims against pharmaceutical and medical device manufacturers

10:15
Morning Coffee Break
10:30
Examining New Class Action Activity in the Managed Care Space

Mary Beth Edwards
Senior Managing Director
Ankura (Washington, D.C.)

Geoffrey M. Sigler
Partner
Gibson, Dunn & Crutcher LLP (Washington, DC)

Jaime Stilson
Partner
Dorsey & Whitney LLP (Minneapolis, MN)

Thomas J. Sullivan
Partner
Shook Hardy & Bacon L.L.P. (Philadelphia, PA)

  • Overview of the recent class action activity and its impact on the industry in the last year
  • Exploring recent theories of liability being asserted by the plaintiffs’ attorneys
  • Best strategies employed by the MCOs to defend these cases

11:15
A Practical Guide for Assessing and Responding to Potential Data Breach

Jamie R. Kurtz
Principal
Robins Kaplan LLP (Minneapolis, MN)

Pamela C. Williams
Senior Vice President & Counsel, Litigation
Anthem, Inc. (Indianapolis, IN)

Jeffrey D. Grossman
Partner
Stradley Ronon Stevens & Young, LLP (Philadelphia, PA)

  • Assessing whether and when a company has to disclose that there is inadvertent release of protected health information – what are the disclosure requirements?
  • Once the risk has become apparent, what are the best strategies for assessing potential data breach?
  • What are the steps in-house counsel at a managed care organization should follow to ensure an adequate response to the data breach?

12:15
Networking Luncheon
1:15
Spotlight on Antitrust: Disputes and Investigations Involving Contracting Practices Between Providers and Payors in Managed Care

Mike Cowie
Partner
Dechert LLP (Washington, D.C.)

Peter J. Mucchetti
Chief, Healthcare and Consumer Products Section
Antitrust Division

DOJ (Washington, D.C.)

Christine L. White
Vice President, Office of Legal Affairs
Northwell Health, Inc. (New Hyde Park, NY)

Contracting practices with hospital systems and other healthcare providers often raise significant antitrust issues. These issues arise both in government investigations and in private litigation. Antitrust issues arise from provider steering and transparency restrictions, use of narrow or tiered networks, referenced based pricing most-favored-nation terms, and from other contracting practices. This session will explore best practices for managed care companies to minimize antitrust risks and for potential offensive use of antitrust to achieve commercial objectives.

2:15
What Do Payors Need to Be Aware of with Respect to PBM Litigation

Mark Bina
Partner
Quarles & Brady LLP (Chicago, IL)

Suzette Schommer
AVP, Assistant General Counsel – Litigation
Prime Therapeutics (Bloomington, MN)

  • Current developments with the PBM litigation and how they are impacting payors; How can MCOs potentially be pulled into this litigation?
  • Based on the case developments thus far, how can payors generate revenue or offset fees through PBM practices?
  • Examining the current regulatory discussions about potentially eliminating rebates all together

3:00
Conference Ends