Managed Care Disputes and Litigation

January 25 – 26, 2022

Agenda

Conference Program
Flip through our 2021 conference brochure and discover what’s new this year.

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Day 1 - Wednesday, June 9, 2021

8:45	Opening Remarks from the Co-Chairs
9:00	Forecasting the Future of Managed Care: Status of ACA and How to Prepare for A New Regulatory Regime Under the Biden Administration
9:30	In-House Counsel Roundtable: The Most Pressing Legal and Operational Challenges for 2021
10:30	Break
11:00	Anticipating the Future Implications of COVID-19 for Managed Care
11:45	1:1 Networking
12:00	Break
12:30	SPOTLIGHT ON LEGISLATIVE DEVELOPMENTS Assessing the Impact of Pricing Transparency Legislation Implementation on Managed Care Networks
1:15	Status Report on Surprise Billing Legislation
1:45	Break
2:00	Building Better In-House and Outside Counsel Relationships: Industry Best Practices and Ethical Considerations
3:00	Risk Adjustment: How to Navigate the Regulatory and Litigation Landscape During the Pandemic
3:45	Break
4:15	Cyber Security and Privacy Practices to Protect Patient Data and Mitigate Litigation and Regulatory Risk
4:45	How Health Insurers Should Approach Telehealth
5:45	Day One Ends

Day 2 - Thursday, June 10, 2021

9:00	Opening Remarks from the Co-Chairs
9:15	Behavioral Health and Non-Traditional Therapies: Emerging Considerations for Scope of Coverage
10:15	False Claims Act Year in Review: The Most Notable Cases, Trends and Enforcement Actions for MCOs
11:00	1:1 Networking
11:10	Break
11:30	SPECIAL FOCUS ON ANTITRUST Addressing Anti-Competitive Terms in Payor-Provider Contracts
12:30	Analyzing Emerging Hospital and Provider Merger Enforcement
1:00	Break
1:45	Affirmative Cost Recovery: How Plans Should Approach Litigation Against Third Parties
2:30	Payor-Provider Litigation Landscape: Managing Disputes involving Contracted and Non-Par Providers
3:30	Break
3:45	Examining the Latest Litigation Against PBMs
4:30	How to Navigate Healthcare Provider Bankruptcy: What MCOs Need to Know about Contracts Terms, Purchaser Liability
5:15	Conference Concludes

Day 1 - Wednesday, June 9, 2021

8:45	Opening Remarks from the Co-Chairs Timothy McMichael Assistant General Counsel Director of Litigation and Special Investigations Unit Premera Blue Cross Caroline L. Schiff Assistant General Counsel, Litigation and Investigations Humana Inc.
9:00	Forecasting the Future of Managed Care: Status of ACA and How to Prepare for A New Regulatory Regime Under the Biden Administration MaryBeth Musumeci Associate Director, Program on Medicaid and the Uninsured Kaiser Family Foundation Examining the potential path for ACA following the Supreme Court’s anticipated decision on the constitutionality of the individual mandate How MCOs, providers and members should prepare to navigate changes to Medicaid Monitoring Medicaid legislative and regulatory developments at CMS Status of Medicaid work and reporting requirements New federal funding for Medicaid home and community-based services Medicaid managed care rules How to prepare for impending HHS regulations
9:30	In-House Counsel Roundtable: The Most Pressing Legal and Operational Challenges for 2021 Jerome Kearns Senior Director, Regulatory Affairs Sidecar Health Akure Ahaghotu Paradis Deputy General Counsel CareSource Raymond Walker Managing Counsel Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas Moderator: Ursula Taylor Founding Partner The Law Offices of Ursula Taylor LLC Leadership: How to effectively lead your legal teams in the COVID and post-COVID environment. Diversity, Equity and Inclusion: Creating and supporting diverse teams and perspectives. Outside Counsel: Evolving approaches to maximizing relationships with your outside counsel. Serving the Business: How in-house legal teams effectively partner with their internal clients.
10:30	Break
11:00	Anticipating the Future Implications of COVID-19 for Managed Care Lou Patalano Chief Legal Officer, Corporate Vice President & Corporate Secretary Sentara Healthcare & Optima Health Ashlee Knuckey Partner Locke Lord LLP Jeff Joseph Wurzburg Senior Counsel Norton Rose Fulbright US LLP Analyzing the impact of COVID on MCOs, providers and members Understanding COVID related billing; what’s covered, what’s not and identifying where disputes could arise Determining payor responsibility as it relates to COVID vaccines and treatments What does the CARES Act require from payors?
11:45	1:1 Networking Take advantage of this networking break and see how many people you meet. To maximize your connections, benefit from virtual business card exchange opportunities.
12:00	Break
12:30	SPOTLIGHT ON LEGISLATIVE DEVELOPMENTS Assessing the Impact of Pricing Transparency Legislation Implementation on Managed Care Networks Archana Rajendra Senior Counsel Henry Ford Health System and Health Alliance Plan of Michigan Peggy Beat Lawyer Axiom The transparency rule, requiring hospitals to publish a consumer-friendly list of payor-negotiated rates for healthcare services went into effect on January 1, 2021. It’s unclear whether Biden will revise the rule, finalized by the CMS in late 2019 or if the new administration will exercise enforcement discretion as providers work to implement the change. This session will explore impact on both payors and providers. Status update on CMS transparency rules and projected impact on managed care networks Anticipating potential friction due to interoperability hurdles for information sharing from MCOs to providers and members Examining how CMS enforcement measures are being applied How to overcome operational challenges to achieve compliance
1:15	Status Report on Surprise Billing Legislation Max Czernin Partner Squire, Patton, Boggs LLP Michelle Skipper Vice President American Arbitration Association Examining the interplay between the federal “No Surprises Act” and current state laws Assessing the impact of anti-surprise billing legislation in California and the impact on managed care litigation Understanding the scope of coverage under these laws Where the responsibility for reimbursement falls for out of network physicians providing care at an in-network hospital with the backdrop of transparency laws Analyzing the impact on provider-payor litigation over reimbursement claims for emergency services and non-emergency services at an in-network facility with an out of network provider How the federal and state enforcement regimes will work together
1:45	Break
2:00	Building Better In-House and Outside Counsel Relationships: Industry Best Practices and Ethical Considerations James Peacock Vice President and General Counsel Scott and White Health Plan Brandie Gasper Senior Assistant General Counsel Molina Healthcare Jonathan M. Herman Managing Member Herman Law Firm Examining the top do’s and don’ts between in-house and outside counsel How to manage ethical considerations faced by both in-house counsel and outside counsel in dealing with their respective clients Crafting effective budgets Managing alternative fee arrangements
3:00	Risk Adjustment: How to Navigate the Regulatory and Litigation Landscape During the Pandemic J. Gabriel McGlamery Senior Health Care Policy Consultant, Government Relations Florida Blue Michael S. Kolber Partner Manatt, Phelps & Phillips LLP Exploring the regulatory and enforcement developments in risk adjustment as it relates to the current COVID environment Identifying key takeaways from actions by insurers against CMS for alleged underpayment as well as regulatory actions for overpayment Examining differentiation of market segments and how commercial risk adjustment is drifting away from adverse selection The evolution of RADV – what was fixed and what’s still broken
3:45	Break
4:15	Cyber Security and Privacy Practices to Protect Patient Data and Mitigate Litigation and Regulatory Risk Layna Rush Shareholder Baker Donelson Timothy McMichael Assistant General Counsel Director of Litigation and Special Investigations Unit Premera Blue Cross Examining the latest class action and other litigation or regulatory activity related to data and security breaches Practical steps to take following a breach to mitigate limit litigation and regulatory risk How to integrate and maintain a secure platform to protect against potential breaches Applying HIPPA, e-PHI compliance best practices to prevent the inadvertent release of patient information
4:45	How Health Insurers Should Approach Telehealth Eliot M. Burriss Partner Holland & Knight LLP David E. Kopans Of Counsel Jones Day Viktoriya Torchinsky-Field VP Chief Counsel, Litigation Cigna Understanding the licensing parameters and how the scope of practice is being expanded at the state level Navigating reimbursement landscape during and post-COVID Extent and duration of emergency measures Understanding the potential benefits as well as the opportunities for fraud and abuse Learning about criminal and civil actions involving false and fraudulent claims Reviewing CMS regulatory changes to address billing fraud of government payors Navigating the OIG exception to beneficiary inducement prohibitions of the civil monetary penalties law to allow for telehealth technologies for end-stage renal disease
5:45	Day One Ends

Day 2 - Thursday, June 10, 2021

9:00	Opening Remarks from the Co-Chairs Timothy McMichael Assistant General Counsel Director of Litigation and Special Investigations Unit Premera Blue Cross Caroline L. Schiff Assistant General Counsel, Litigation and Investigations Humana Inc.
9:15	Behavioral Health and Non-Traditional Therapies: Emerging Considerations for Scope of Coverage Thomas J. Sullivan Partner Shook, Hardy & Bacon LLP Deepti A. Loharikar Director of Regulatory Affairs Association for Behavioral Health and Wellness Examining the implications of the Wit v. United Behavioral Health on MCOs, providers and members Status of the Mental Health Parity and Addiction Equity Act In-depth review of impending regulatory changes California Law Translating clinical standards into insurer guidelines Implications for out of network related disputes
10:15	False Claims Act Year in Review: The Most Notable Cases, Trends and Enforcement Actions for MCOs Jacob T. Elberg Former Federal Prosecutor; Professor Seton Hall School of Law (Newark, NJ) Preston L. Pugh Partner Crowell Moring LLP Analyzing the latest recent FCA cases and enforcement trends affecting MCOs In-depth review of defenses and court rulings Key compliance lessons to mitigate FCA liability Examination of disputes over fraud in government healthcare programs Recent actions involving Medicare and Medicaid managed care
11:00	1:1 Networking Take advantage of this networking break and see how many people you meet. To maximize your connections, benefit from virtual business card exchange opportunities.
11:10	Break
11:30	SPECIAL FOCUS ON ANTITRUST Addressing Anti-Competitive Terms in Payor-Provider Contracts Abigail Wood Deputy Attorney General, Antitrust Section Pennsylvania Attorney General's Office Karl Knutsen Attorney, Antitrust Division U.S. Department of Justice Moderator: Mike Cowie Partner Dechert LLP This panel will discuss ongoing developments in antitrust affecting the managed care arena with an aim to spotting and avoiding problematic contract terms. The forum brings together enforcers at the U.S. Justice Department and the Pennsylvania State Attorney’s General Office to discuss topics, such as anti-steering clauses, all-or-nothing clauses, gag clauses and other clauses that may restrict competition. Identifying anticompetitive terms in provider contracts Overview of enforcement actions and private litigation Views of government enforcers and company counsel
12:30	Analyzing Emerging Hospital and Provider Merger Enforcement Alex Bryson Attorney, Mergers IV Federal Trade Commission Lumi Nodit Assistant Attorney General Washington Attorney General’s Office Antitrust Division Peter J. Mucchetti Partner Clifford Chance US LLP This panel will discuss developments in hospital merger enforcement under the new administration. Critical considerations include geographic extension or cross-market mergers and vertical consolidation between hospitals and other types of providers. Critical points of discussion include: Analyzing potential vertical effects for proposed mergers as the lines between providers and insurers continue to blur Investigating cross-market healthcare provider mergers, assessing whether cross-market mergers affect competition Examining the types of evidence enforcers seek to assess cross-market issues Determining how traditional horizontal hospital and provider mergers will evolve and the future of investigations
1:00	Break
1:45	Affirmative Cost Recovery: How Plans Should Approach Litigation Against Third Parties Matthew R. Varzally Senior Legal Counsel, Litigation CVS Health Kirstin B. Ives Partner Falkenberg Ives LLP Moderator: Caroline L. Schiff Assistant General Counsel, Litigation and Investigations Humana Inc. Examining the pros and cons to affirmative recovery measures Practical insights on how to identify cases and determine which ones to pursue Examining timely examples of the type of cases that can be pursued Assessing best strategies for pursing affirmative recovery When to include co-plaintiffs
2:30	Payor-Provider Litigation Landscape: Managing Disputes involving Contracted and Non-Par Providers Adam J. Petitt Partner Stradley Ronon Stevens & Young, LLP Tony Rodriguez Vice President, Assistant General Counsel Kaiser Foundation Hospitals/Health Plan Jon Rose Senior Litigation Counsel HCA Healthcare In this session, our esteemed panelists will examine recent, notable provider-payor disputes. Extract critical lessons from how these cases were managed for your case strategy. In patient v. out-patient coverage disputes stemming Determinations of “medically necessary” procedures Executing audits of in patients v. out-patients to inform reimbursement and recovery decisions Provisions for in network and out of network emergency services Examine trends in billing disputes involving ground and air ambulance
3:30	Break
3:45	Examining the Latest Litigation Against PBMs Richard J. Merino Senior Managing Director Ankura Consulting Group Examining the supreme court decision in Rutledge v. Pharmaceutical Care Management Association How the decision to uphold the Arkansas Act and dismiss ERISA pre-emption will impact PBM drug price setting Examining recent opioid related claims asserted against PBMs—and the projected impact, more broadly for drug litigation Anticipating new legislative and regulations on drug pricing
4:30	How to Navigate Healthcare Provider Bankruptcy: What MCOs Need to Know about Contracts Terms, Purchaser Liability Beatriz Jaramillo Senior Counsel Humana Inc. Jennifer Sucher Partner Fox Swibel Levin & Carroll LLP Overview of the Chapter 11 process and key milestones during the bankruptcy Understanding the impact of the filing of the petition and the automatic stay Using best practices to manage bankruptcies and the importance of the business teams and legal working to identity issues and risks Conducting business with a provider in bankruptcy – when do you need bankruptcy court approval and how is your provider agreement impacted Recognizing a debtor’s rights to assume, assume and assign or reject an executory contract Identifying key provisions in plans of reorganization and sales motions and how they may impact your contractual rights
5:15	Conference Concludes

Event Contacts

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American Conference Institute

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American Conference Institute

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