Managed Care Disputes and Litigation

March 29 – 30, 2023

Agenda

Day 1 - Wednesday, March 30, 2022

8:45	Co-Chairs’ Opening Remarks
9:00	In House Counsel Hot Topics Examining How the Latest Industry Trends, Challenges and Opportunities are Shaping In-House Priorities and Responsibilities
10:00	Fireside Chat on the Managed Care Industry 2022 and Beyond
10:30	Break
10:45	Anticipating the Impact of the No Surprises Act on Payors and Health Care Providers
11:30	Vertical Integration: Antitrust Planning and Risk Mitigation Considerations for Payors
12:15	Networking Lunch
1:15	Payor-Provider Litigation: Building Your Case Strategy with Lessons from the Most Influential Decisions of the Past Year
2:00	Case Study Litigating Behavioral Health Claims: The Biggest Wins, Losses and Future Considerations for Payors
2:45	Break
3:00	Legal Landmines for MCOs in the Digital Landscape and How to Avoid them
3:45	Part I - Interactive Breakout Discussions How to Define, Assess and Improve DEI in All Aspects of the Business
4:30	How to Navigate Client Expectations: The Top Dos, Donts and Ethical Considerations for Inside and Outside Counsel
5:30	Conference Adjourns—Cocktail Reception

Day 2 - Thursday, March 31, 2022

8:45	Co-Chairs’ Opening Remarks
9:00	Fraud and Abuse: Tracking the Latest in Medicare and Medicaid Related Enforcement Actions and What it Means for Payors Moving Forward
10:00	Spotlight on California What MCOs Need to Know about Golden State Standards and the Implications for the Rest of the Nation
10:30	Break
10:45	Blip or Wave? Examining COVID-19 Related Disputes and Litigation Involving MCOs and Anticipating What the Future Holds
11:45	How MCOs Should Approach Value-Based Contracts
12:30	Networking Lunch
1:30	Social Determinants of Health and Promoting Health Equity: New and Emerging Coverage Considerations in Support of Improved Health Outcomes and the Business
2:15	Medical Loss Ratio Compliance and Enforcement Considerations for MCOs
2:45	Break
3:00	Affirmative Litigation Against Drug Manufacturers: “ Pay-for-Delay” Antitrust Claims and Other Recovery Opportunities
4:00	Cyber Security, Privacy and Ransomware: Critical Steps to Take in the 24-Hours Following a Data Breach
5:00	Conference Concludes

Day 1 - Wednesday, March 30, 2022

8:45	Co-Chairs’ Opening Remarks Viktoriya Torchinsky-Field VP Chief Counsel Cigna Denise Zamore Deputy General Counsel Optum
9:00	In House Counsel Hot Topics Examining How the Latest Industry Trends, Challenges and Opportunities are Shaping In-House Priorities and Responsibilities Marguerita Brunson Sims Senior Counsel CareSource Raymond Walker Managing Counsel Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas Inbal Hasbani Senior Counsel Cigna Moderator: Denise Zamore Deputy General Counsel Optum Topics Include: Diversity, Equity, and Inclusion: How to create and support diverse teams and perspectives How to handle public communication about major disputes Best practices for setting relationships with outside counsel up for success How to set and manage expectations: top dos and donts Technology: How is this changing in-house responsibilities as it relates to record creation, and retention in the context of litigation Change management strategies How has the pandemic impacted the business? Developing strategies to attract and retain talent
10:00	Fireside Chat on the Managed Care Industry 2022 and Beyond Marianne Short EVP, General Counsel UnitedHealth Group Moderator: Viktoriya Torchinsky-Field VP Chief Counsel Cigna
10:30	Break
10:45	Anticipating the Impact of the No Surprises Act on Payors and Health Care Providers Archana Rajendra Senior Counsel Henry Ford Health System and Health Alliance Plan of Michigan JoAnna Younts Director BRG Overview of HHS requirements under the No Surprises Act, and the implications for payors, providers, and patients Examining the newly established independent dispute resolution (IDR) process for determining out-of-networking rates for service Timelines for negotiation, what’s required of payors Analysis IDR process utilization for balance billing disputes and practical takeaways What happens when a party objects a proposed arbitrator? Examining guiding principles for arbitrators overseeing the dispute resolution process Anticipate how the difference between state and federal laws will impact settlements, premiums, and potential shifts towards more in-network providers
11:30	Vertical Integration: Antitrust Planning and Risk Mitigation Considerations for Payors Liz Brady Interim Co-Director, Antitrust Division, Florida Office of Attorney General Mike Cowie Partner Dechert LLP Joseph Miller Member/Co-Chair, Antitrust Practice Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. The Biden Administration has jettisoned the Vertical Merger Guidelines, creating uncertainty while new guidelines are under consideration. In the current environment, Health insurers may combine with hospitals or physician groups through acquisition, joint venture, or other forms of collaboration. This session will explore: How health insurers and providers should assess the antitrust risks associated with vertical integration What criteria should be used? In-depth examination of what steps can be taken to mitigate risks
12:15	Networking Lunch
1:15	Payor-Provider Litigation: Building Your Case Strategy with Lessons from the Most Influential Decisions of the Past Year Adam J. Petitt Partner Stradley Ronon Stevens & Young, LLP Geoffrey Sigler Partner Gibson Dunn Paul Weller Partner Robins Kaplan LLP Moderator: Matt Ryan Senior Managing Director, Disputes & Economics Ankura This session will offer a detailed examination of some of the year’s most notable coverage disputes involving in-network and out of network providers. Pinpoint the issues being frequently litigated, involving overpayment recovery, and provider underpayment claims.
2:00	Case Study Litigating Behavioral Health Claims: The Biggest Wins, Losses and Future Considerations for Payors Brad Lerner Director, Public Policy, Manager, Behavioral Health and Enterprise Issues Anthem Ben McCoy Partner Fox Rothschild LLP Behavioral health coverage continues to be a developing, and critical focus for MCOs. This session will focus on: How level of care requirements for health insurers under the Mental Health Parity and Addiction Equity Act are impacting cases How to approach coverage for residential treatment centers, and wilderness treatment therapy claims Emerging issues stemming from the use of telemedicine for mental health Analysis of where payors have been successful in behavioral health disputes
2:45	Break
3:00	Legal Landmines for MCOs in the Digital Landscape and How to Avoid them David E. Kopans Of Counsel Jones Day How to mitigate third party risks through enforceable contracts Assessing new and emerging legal risks stemming from negligent credentialling Analysis of telehealth-specific fraud and abuse risks and enforcement actions
3:45	Part I - Interactive Breakout Discussions How to Define, Assess and Improve DEI in All Aspects of the Business Brian P. Seaman Counsel and Chief Diversity Officer Stradley Ronon & Young LLP Denise Zamore Deputy General Counsel Optum
4:30	How to Navigate Client Expectations: The Top Dos, Donts and Ethical Considerations for Inside and Outside Counsel Hilary Dudley AVP Senior Counsel of Litigation CVS Health Jonathan Herman Partner Herman Law Akure Paradis Deputy General Counsel CareSource Kimberly J. Donovan Partner Squire, Patton, Boggs
5:30	Conference Adjourns—Cocktail Reception

Day 2 - Thursday, March 31, 2022

8:45	Co-Chairs’ Opening Remarks
9:00	Fraud and Abuse: Tracking the Latest in Medicare and Medicaid Related Enforcement Actions and What it Means for Payors Moving Forward Megan Tinker Assistant Inspector General HHS Office of Inspector General Ed Baker Of Counsel Constantine Cannon Identifying types of fraud, including falsified diagnoses, unnecessary treatment, and upcoding practices Examining cases involving Medicare Advantage plans and risk adjustment investigations by the DOJ Assessing the implications of the decision on the overpayment rule in United V. Azar, on past and present FCA cases A rundown of recent FCA and AKS related cases impacting MCOs
10:00	Spotlight on California What MCOs Need to Know about Golden State Standards and the Implications for the Rest of the Nation Sarah Ream Chief Counsel California Department of Managed Care Network adequacy Minimum plan benefits California Department of managed care’s efforts to create statewide standards for managed care
10:30	Break
10:45	Blip or Wave? Examining COVID-19 Related Disputes and Litigation Involving MCOs and Anticipating What the Future Holds Timothy McMichael Assistant General Counsel Director of Litigation and Special Investigations Unit Premera Blue Cross Eli Burriss Partner Katten Muchin Rosenman LLP Ashlee Knuckey Partner Locke Lord LLP Moderator: Amanda L. Genovese Partner Troutman Pepper Hamilton Sanders LLP 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, treatments, and testing Identifying where there are opportunities to recover funds
11:45	How MCOs Should Approach Value-Based Contracts Tiffany Wandy Executive Director, Clinically Integrated Network LifeBridge Health Selina P. Coleman Partner Reed Smith LLP (Washington, DC) Understanding the OIG and CMS safe harbors for value-based arrangements under AKS and the Stark Law Considering the risks and benefits of value-based arrangements Anticipating disputes related to value-based arrangements
12:30	Networking Lunch
1:30	Social Determinants of Health and Promoting Health Equity: New and Emerging Coverage Considerations in Support of Improved Health Outcomes and the Business Melinda J. Dutton Partner Manatt, Phelps & Phillips, LLP Analysis of how SDoH initiatives, such a food security focused programs, are improving the overall health of plan members and reducing costs Applying lessons learned on how to implement SDOH initiatives and measure the cost/benefit outcome Key considerations for partnerships and contracting with health providers and other stakeholders How to mitigate fraud and abuse risks in the implementation of SDoH programs
2:15	Medical Loss Ratio Compliance and Enforcement Considerations for MCOs Elizabeth M. Bock Partner O'Melveny & Myers LLP Alex Oliphant Director BRG Defining Medical Loss Ratio (MLR), the history of MLR reporting and enforcement, and the risks associated with MLR submissions Statutory requirements and data reporting considerations for MLR data submission as well as analysis of the public use files for 2014-2019 for Medicare Advantage Examining the legal risks posed when submitting MLR data and what steps can be taken to mitigate those risks
2:45	Break
3:00	Affirmative Litigation Against Drug Manufacturers: “ Pay-for-Delay” Antitrust Claims and Other Recovery Opportunities James Cash Senior Counsel Humana Kathy Kottos Senior Associate Counsel Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas Peter D. St. Phillip Jr. Partner, Head of Litigation Lowey Dannenberg Considerations surrounding which opportunities to bring to the courts Why bringing cases makes economic sense for the company Key considerations for counsel selection Case strategies Supporting your claim with dataExpected discovery burdens Assessing concerns over positional conflicts – are they valid? Top settlement considerations
4:00	Cyber Security, Privacy and Ransomware: Critical Steps to Take in the 24-Hours Following a Data Breach Brian Lichter VP Stroz Friedberg Kellen Dwyer Partner Alston & Bird LLP How to revamp company policies to comply with privacy regulations pertaining to the transfer of digital health information Examining the evolving threat landscape and how to take a proactive approach within your organization Practical examples types of breaches, lessons learned and best practices to thwart them Everything you have wanted to know about ransomware attacks and how to formulate an effective response strategy
5:00	Conference Concludes

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