Registration Opens

Conference Chair’s Opening Remarks

Akure Paradis
Deputy General Counsel
CareSource

Archana Rajendra
Vice President and Deputy General Counsel
Health Alliance Plan, Henry Ford Health

Managed Care Policy Briefing: Assessing Midterm Election Aftermath, and What the New Political Agenda Could Mean for MCOs

Philo D. Hall
Partner
Epstein Becker & Green, PC

Join us for an in-depth discussion and analysis of what the Mid -Term results mean for the MCO community. This forward-looking session will dissect how the flip to a Republican controlled House, and a Democratic majority in the Senate will impact the legislative agenda and the Biden administration’s health policy priorities. Key topics to be discussed include:

• Drug pricing
• Medicare Advantage payment rates
• How state health policy priorities are changing, including reproductive rights
• The future of Medicare value-based care
• Examining the impact on the judiciary, and key legal questions impacting managed care

Payor Risks in a Post-Dobbs World: How to Navigate the Complexities of Reproductive Health Coverage and Pinpoint Potential Litigation

Heather Richardson
Partner
Gibson Dunn LLP

Thomas J. Sullivan
Partner
Shook, Hardy & Bacon LLP

On June 23, 2022, the Supreme Court in Dobbs V. Jackson Women’s Health Organization decision overturned fifty years of precedent on abortion laws in America. The legal consequences of this monumental decision will require close attention from stakeholders across the healthcare industry including MCOs. This session will focus on:

• Examining conflicting state laws on reproductive health coverage post-Dobbs
• How to manage claims for patients that are seeking care outside their home state
• Identifying potential risks for payors
• When is paying for abortions considered illegally aiding and abetting
• Coverage determinations for abortion-inducing drugs and telemedicine abortion services across state lines
• Anticipating what the future litigation landscape could look like and the proactive risk mitigation measures to take

Morning Coffee and Networking Break

FOCUS ON THE NO SURPRISES ACT - PART I

The Next Chapter in the NSA Saga—Analyzing the Evolution of the No Surprises Act and How it’s Playing Out in Practice for MCOs

Ray Walker
Managing Counsel – Litigation
Blue Cross and Blue Shield of Texas

Alexandra M. Lucas
Partner
Reed Smith LLP

• Examining recent legal challenges to provisions in the NSA and the implications for the process moving forward
• How QPA is being used in the IDR process for out-of-network services subject to the NSA
• Navigating the intersection of federal and state laws on surprise billing
• Complying with AEOB requirements
• Payor-provider perspectives, and key takeaways on how the process is performing to date

PART II: ROUNDTABLE DISCUSSION

Navigating the NSA: Open Discussion on Key Challenges, and Takeaways from Recent Experiences with the Dispute Resolution Process

Alexandra M. Lucas
Partner
Reed Smith LLP

Ray Walker
Managing Counsel – Litigation
Blue Cross and Blue Shield of Texas

Contribute to the conversation on the No Surprises Act with this special opportunity to engage around the table with in-house and outside counsel. Share takeaways from a recent experience with the IDR process, raise questions and provide perspectives on the future of the NSA and how to prepare as an organization.

Trends in Payor-Provider Disputes and Industry Tested Techniques for Managing Them More Effectively

Kevin D. Feder
Partner
O’Melveny & Myers LLP (Washington, DC)

Evan Neadel
Assistant General Counsel
Horizon Blue Cross Blue Shield of New Jersey

Matt Ryan
Senior Managing Director, Disputes & Economics
Ankura

• Hospital staffing shortages, COVID-19 pressures, and inflation

• In patient v. out-patient coverage disputes
• Determinations of “medically necessary” procedures
• Ground ambulance disputes

Networking Luncheon

LIVE POLLING

What Every MCO Lawyer and Executive Needs to Know about ESG

Lindsay Fetzer
Partner
Bass, Berry & Sims

Archana Rajendra
Vice President and Deputy General Counsel
Health Alliance Plan, Henry Ford Health

• Defining ESG within the managed care context
• Determining who owns ESG risks and oversight within the organization—whether it is general counsel or if it falls to another part of the business
• Best practices for establishing metrics, and benchmarking with other organizations
• Identifying future litigation risks, and enforcement activity
• Practical risk mitigation measures to put in play now

DEI Leadership Think Tank: How Individual Action Can Drive Change at Managed Care Organizations

Brian P. Seaman
Counsel and Chief Diversity Officer
Stradley Ronon & Young LLP

This interactive breakout session will explore how you can move the dial on DEI at your organization. Engage with in-house and outside counsel on how to build and support diversity within your legal teams. Key these to be explored include:

• How individuals at plans and their outside counsel can take responsibility for DEI within their respective organization
• Bystander intervention: Explore hypotheticals illustrating allyship best practices
• Applying a DEI lens to internal and external communication

Afternoon Coffee and Networking Break

Medical Loss Ratio: Key Data Reporting Considerations and Risk Areas for MCOs

Elizabeth M. Bock
Partner
O'Melveny & Myers LLP

Alex Oliphant
Director
BRG

• Examining the legal risks posed when submitting MLR data and what steps can be taken to mitigate those risks
• Factoring in statutory requirements and data reporting considerations for MLR data
• Top takeaways from MLR enforcement

Uncovering COVID-19 Schemes: How Payors Should Approach Recovery Opportunities Post-Pandemic

Tim McMichael
Assistant General Counsel- Director of Litigation/SIU
Premera Blue Cross

Adam J. Petitt
Partner
Stradley Ronon Stevens & Young, LLP

• Understanding how coverage requirements for COVID-19 testing are changing as the pandemic winds down
• Tracking the evolution of federal and state reimbursement telehealth la
• Affirmative litigation opportunities to recover overpayments, and address potentially fraudulent claims
• Examining recent disputes with testing labs over billing and coding practices
• Managing claims that procedures listed online not reimbursed properly

HIPAA Compliance and Cyber Security: Best Practices for MCOs in the Age of Mobile Apps and Data Tracking Technology

Kirk J. Nahra
Partner and Co-Chair, Cybersecurity and Privacy Practice
WilmerHale (Washington, DC)

• Examining HIPAA compliance obligations for payors and providers using third-party data tracking technology on websites or mobile devices
• Assessing the risk of transmitting personal health information
• Complying with the breach notification rule
• Building compliance strategies around new HHS guidance and forecasting future litigation in this area
• Takeaways from recent class action lawsuits
• Lessons learned from recent litigation involving data trackers, and other data breach cases

Cocktail Reception

Registration Opens

Conference Chair’s Opening Remarks

Akure Paradis
Deputy General Counsel
CareSource

Archana Rajendra
Vice President and Deputy General Counsel
Health Alliance Plan, Henry Ford Health

From the Office of the Inspector General: Emerging FWA Risks, and Key Priorities for 2023 and Beyond

Carolyn Kapustij
Senior Advisor for Managed Care
HHS Office of Inspector General

The OIG is heavily focused on fighting fraud, waste, and abuse within managed care. To that end, recent oversight efforts have focused on Medicare Advantage risk-adjusted payments, health risk assessments, chart reviews and the accuracy of provider data.

In this session hear directly from the HHS-OIG on 2023 initiatives, emerging areas of risk for MCOs, and key takeaways from recent compliance audits.

FCA Outlook: Top Trends and Enforcement Activity for MCOs to Watch

Brett Barnett
Partner
McGuireWoods LLP

Jay Dewald
Partner
Norton Rose Fulbright LLP

Jed Wulfekotte
Partner
Crowell & Moring LLP

• Identifying the types of FCA cases emerging in Medicare and Medicaid managed care
• Adding codes, upcoding, false diagnoses, kickbacks, and compliance lapses
• Tracking FCA recoveries for 2022
• Examine recent DOJ criminal and civil actions taken against MCOs
• Practical insights on what they are looking for in investigations
• Exploring the latest from the Qui Tam bar
• Lesson learned from claims filed against MCO’s by Plaintiffs’ attorneys

Morning Coffee and Networking Break

Arbitration, Mediation and Mixed Modes: Perspectives on ‘Switching Hats’ to Resolve Managed Care Disputes

Elliot K. Gordon
Arbitrator/Mediator

Barbara Reeves
Arbitrator, Mediator, Special Master

Emily Wey
Arbitrator and Mediator
Wey West Dispute Resolution

Lawyers and their clients come into arbitration or mediation wanting a result. They want to win, but they also want expeditious and less expensive dispute resolution. Combining a mixture of mediation and arbitration in the same case with the same neutral is a useful technique to understand. Just as drivers on a multi-lane highway shift from lane to lane as circumstances require while reaching their destination, disputants can move from settlement modes to arbitration and back again as circumstances warrant.

This session will explore when, and how to effectively engage these and other dispute-resolution tools in the managed care environment. Panelists will provide insights on:

• When and how to leverage mediation and arbitration tools in managed care disputes
• Tips on how to structure an efficient process
• Examples of managed care disputes resolved through mixed modes
• A behind-the-scenes look at what persuades arbitrators and how mediators work

MCOs on Trial: War Stories, and Winning Strategies from In-House and Outside Counsel

Jamie Kurtz
Co-Chair, Health Care Litigation Group
Robins Kaplan LLP

Jason Joffe
Partner
Squire Patton Boggs

Matthew R. Varzally
Senior Legal Counsel, Litigation
CVS Health

Ben McCoy
Partner
Fox Rothschild LLP

The trial is where the in-house outside counsel relationship is put to the test. In this session learn best practices for working together to secure a favorable outcome, and the pitfalls to avoid along the way.

Networking Luncheon

The Future of Mental Health Coverage, Access and Litigation

Brad Lerner
Director, Public Policy
Elevance Health

Heather D. Redmond
Deputy General Counsel
UnitedHealth Group

Jen Romano
Partner
Crowell & Moring LLP

Amanda G. Schreiber
Associate Senior Counsel
Cigna

Moderator:

Kara Wheatley
Principal
Groom Law Group, Chartered

There is bipartisan support in congress for mental health reform. Examine how these ambitious policies are shaping up and the implications for the legal landscape.

Part one of this panel discussion will explore the future of mental health policy, including continuing enforcement challenges related to mental health parity and potential policy actions that could help improve access to mental health and SUD care.

Part two will take a closer look at burgeoning legal challenges, and strategies for defending a MHPAEA claim.

Key points of discussion include:

• Determining what laws need to be made to facilitate better access, evidence-based treatment
• Identifying what barriers need to be overcome to enforce and achieve mental health parity
• Exploring how can we fund and enforce these policies
• Predicting the potential direction of the future of mental health policy look like
• Examining how the Mental Health Matters Act strengthens MHPAEA enforcement powers
• Survey of important cases to monitor, and key takeaways from trends in behavioral health cases
• How MCOs should prepare the lawsuit before it’s filed—key strategies for defending MHPAEA claims

Afternoon Coffee and Networking Break

PBMs ‘Put on Notice’: How the FTC Review and Further Government Scrutiny Will Impact the Managed Care Landscape

Mike Cowie
Partner
Dechert LLP

Nicholas John
Associate Director
Berkeley Research Group, LLC

Joseph Miller
Member/Co-Chair, Antitrust Practice
Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

PMBs have come under fire. “The FTC has launched a review of PBM services, including the role of vertical integration and the impact of PBMs on drug pricing. This panel will discuss the role of the FTC and other government actors and how to assess claims made by opposition groups.

Private Equity in the Provider Market: Assessing Investment Trends and the Impact on the Managed Care Industry

Devin Cohen
Partner
Ropes & Gray LLP

Private equity investment amidst healthcare provider consolidation continues to pose challenges and opportunities for the managed care industry. Particularly following COVID-19, successful transactions often hinge on payor-provider alignment, network adequacy, and reimbursement.

In this session, we will explore:

• Private equity provider-side investment structures and regulatory restrictions;
• Physician-provider alignment opportunities and value-based care
• Fraud and abuse considerations; and changes of control and participating provider agreement negotiations

Nuts and Bolts of Value-Based Payment (VBP) Contracting

David E. Kopans
Partner
DLA Piper LLP

• Exploring different types of VBP models
• Considering the risks and benefits of value-based arrangement
• Anticipating hot button areas for disputes between payors and providers
• Understanding key regulatory compliance considerations for VBP models, including risk bearing organization oversight and regulation, the OIG and CMS safe harbors for value-based arrangements under AKS and the Stark Law, physician incentive plans rules, and key privacy considerations
• Discussing best practices for VBP contracts

Conference Concludes