14th Annual Advanced Forum on Managed Care Dispute and Litigation - DS

14 TH ANNUAL ADVANCED FORUM ON MANAGED CARE Disputes and Litigation

March 29-30, 2023 • Metropolitan Club, Chicago IL

Network with Top In-House

Professionals from:

• Anthem

• Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

• Caresource

• Cigna

• CVS Health

• Premera Blue Cross

Supporting Sponsors

New Sessions for 2023

Angle-Right Deep Dive into the implications of the Dobbs Decision and where future litigation regarding reproductive rights could arise

Angle-Right Interactive dialogue on how the No Surprises Act is playing out in practice for MCOs

Angle-Right Focus Sessions on ESG and DEI: Key legal and compliance considerations for MCO lawyers and executives

Angle-Right Switching Hats in Managed Care Disputes: Exploring How to Leverage Arbitration, Mediation and Mixed Modes to Achieve a Favorable Result Faster

Distinguished Co-Chairs

Archana Rajendra

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

Akure Paradis Deputy General Counsel CareSource

Special Remarks from the HHS-OIG

Carolyn Kapustij

Senior Advisor for Managed Care HHS Office of Inspector General

Associate Sponsors

Exhibitors

EARN CLE CREDITS

MCOs are in the midst of a legal and regulatory “perfect storm.” They are grappling with legal challenges to the No Surprises Act and pondering the many implications of this litigation. There are also the coverage conundrums stemming from the Dobbs decision — not to mention privacy concerns. If this were not enough, they are also facing government investigations concerning fraud and antitrust violations.

At this time of change, be the first to know how the latest legal and regulatory developments are impacting plans. Identify where litigation risks are bubbling up, and learn to devise strategies and implement plans to meet the challenges of this new environment.

ACI’s Advanced Forum on Managed Care Disputes and Litigation offers an unparalleled learning experience, specifically designed for the MCO legal community. Attend and develop winning legal strategies and business best practices for claims management from our esteemed faculty of outside counsel, in-house lawyers, and executives.

Join us, in person, in Chicago this March for in-depth, analytical, and practical discussions on:

Angle-Right OIG Outlook for 2023: Oversight priorities, risks areas for MCOs, and compliance best practices

Angle-Right Recent experiences with IDR under the NSA: Challenges, key takeaways, and prepare for what’s ahead

Angle-Right Affirmative recovery opportunities coming out of the COVID-19 pandemic

Angle-Right Pleading standards that have emerged for Parity Act claims and tactics for motions to dismiss

Continuing Legal Education Credits

Accreditation will be sought in those jurisdictions requested by the registrants which have continuing education requirements. This course is identified as nontransitional for the purposes of CLE accreditation.

ACI certifies this activity has been approved for CLE credit by the New York State Continuing Legal Education Board.

ACI certifies this activity has been approved for CLE credit by the State Bar of California.

ACI has a dedicated team which processes requests for state approval. Please note that event accreditation varies by state and ACI will make every effort to process your request.

Questions about CLE credits for your state? Visit our online CLE Help Center at www.americanconference.com/accreditation/cle/

MCOs face a highly complex and challenging legal, and regulatory environment fueled by industry collaboration, innovation, and integration

DISTINGUISHED SPEAKER FACULTY

CO-CHAIRS

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

Akure Paradis Deputy General Counsel CareSource

SPEAKER FACULTY

Rachel A. Alexander Partner Wiley Rein LLP

Brett Barnett Partner McGuireWoods LLP

Elizabeth Bock Partner O’Melveny & Myers LLP

Devin Cohen Partner Ropes & Gray LLP

Mike Cowie Partner Dechert LLP

Sandra Durkin Member Strategic Health Law

Jay Dewald Partner

Norton Rose Fulbright LLP

Kevin Feder Partner O’Melveny & Myers LLP

Lindsey Fetzer Partner Bass, Berry & Sims

Elliot K. Gordon, Esq. Mediator, Arbitrator and Referee/Special Master

Philo D. Hall Partner

Epstein Becker & Green, PC

Jason Joffe Partner Squire Patton Boggs

Nicholas John Associate Director Berkeley Research Group, LLC

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

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

Brad Lerner Director, Public Policy Elevance Health

Alexandra M. Lucas Partner Reed Smith LLP

Benjamin McCoy Partner Fox Rothschild LLP

Tim McMichael

Deputy General CounselDirector of Litigation Premera Blue

Joseph Miller Partner Mintz, Levin, Cohn, Ferris, Glovsky, and Popeo

Kirk Nahra Partner WilmerHale

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

Alex Oliphant Director

Berkeley Research Group, LLC

Adam Petitt Partner

Stradley Ronon Stevens & Young LLP

Heather D. Redmond Deputy General Counsel UnitedHealth Group

Barbara Reeves

Arbitrator, Mediator, Special Master JAMS

Heather Richardson Partner Gibson Dunn LLP

Jen Romano Partner Crowell & Moring LLP

Matthew Ryan

Senior Managing Director, Disputes & Economics Ankura

Amanda G. Schreiber Associate Senior Counsel Cigna

Brian Seaman

Counsel and Chief Diversity Officer

Stradley Ronon Stevens & Young LLP

Thomas Sullivan Shook, Hardy, Bacon LLP

Matthew R. Varzally Senior Legal Counsel, Litigation CVS Health

Ray Walker Managing Counsel – Litigation Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

Emily Wey

Arbitrator and Mediator Wey West Dispute Resolution

Kara Wheatley Principal Groom Law Group, Chartered

Jed Wulfekotte Partner Crowell & Moring LLP

PRE-CONFERENCE WORKSHOP

TUESDAY, MARCH 28

9:00am–12:30pm (Registration opens at 8:30am)

Medicare and Medicaid Managed Care Boot Camp: Deep Dive into the Latest Legal and Regulatory Developments

microphone-alt Sandra Durkin, Member, Strategic Health Law

Rachel A. Alexander, Partner, Wiley Rein LLP

Medicare Advantage and Part D programs have become a dominant force in the managed care market.

Both represent a large and growing area of business for MCOs with nearly half of the Medicare eligible population enrolled in a Medicare Advantage plan, a figure that amounted to nearly 28 million people in 2022, and 49 million Medicare beneficiaries in a Part D plan. At the same time that the opportunity associated with this market is growing, federal oversight of these programs is also on the rise. MCOs with government lines of business must navigate a complex web of federal statutes, regulations, and sub-regulatory guidance in their administration. In this workshop, we will facilitate deep discussion of the key issues facing Medicare Advantage and Part D plans today. Come prepared to discuss:

• Current regulatory hot topics and key issues facing plans today, such as marketing, risk adjustment, and prior authorization, with strategies for managing risk and implementing new requirements; and

• Current and upcoming implementation challenges, including implementing key prescription drug pricing provisions in the Inflation Reduction Act and preparing for the changes proposed in the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage program

hands-helping BECOME A SPONSOR

With conferences in the United States, Europe, Asia Pacific, and Latin America, the C5 Group of Companies: American Conference Institute, The Canadian Institute, and C5 Group, provides a diverse portfolio of conferences, events and roundtables devoted to providing business intelligence to senior decision makers responding to challenges around the world.

Don’t miss the opportunity to maximize participation or showcase your organization’s services and talent. For more information please contact us at: SponsorInfo@AmericanConference.com

About us:

The C5 Group, comprising American Conference Institute, The Canadian Institute and C5 in Europe, is a leading global events and business intelligence company.

For over 30 years, C5 Group has proVided the opportunities that bring together business leaders, professionals and international experts from around the world to learn, meet, network and make the contacts that create the opportunities. Our conferences and related products connect the power of people with the power of information, a powerful combination for business growth and success.

SUPPORTING SPONSOR

Crowell & Moring LLP is an international law firm with offices in the United States, Europe, MENA, and Asia. Drawing on significant government, business, industry and legal experience, the firm helps clients capitalize on opportunities and provides creative solutions to complex litigation and arbitration, regulatory and policy, and corporate and transactional issues. The firm is consistently recognized for its commitment to pro bono service and its programs and initiatives to advance diversity, equity and inclusion.

Strong speakers and content. I enjoy this conference every year.

Due to the hands-on nature of the workshop, it is available to in-person attendees only

MAIN CONFERENCE DAY ONE

WEDNESDAY, MARCH 29

7:45 Registration Opens

8:45

Co-Chairs’ Opening Remarks

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

Akure Paradis, Deputy General Counsel, CareSource

9:00

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

microphone-alt 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

9:30

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

microphone-alt Heather Richardson, Partner, Gibson Dunn LLP

Thomas Sullivan, 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

10:15 Morning Coffee and Networking Break

FOCUS ON THE NO SURPRISES ACT

10:45 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

microphone-alt Ray Walker, Managing Counsel – Litigation, Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & 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

11:15 PART II: ROUNDTABLE DISCUSSION

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

microphone-alt Ray Walker, Managing Counsel – Litigation, Blue Cross and Blue Shield of Texas

Alexandra M. Lucas, Partner, Reed Smith LLP

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.

The level of expertise of both the speakers and attendees results in meaningful discussions and practical advice. This has historically been the best conference in Managed Care.

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

microphone-alt

Kevin Feder, Partner, O’Melveny & Myers LLP

Matthew Ryan, Senior Managing Director, Disputes & Economics, Ankura

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

• Assessing the impact of industry and economic factors on dispute resolution and the overall provider relationship

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

• Identifying frequently litigated disputes

» In patient v. out-patient coverage disputes

» Determinations of “medically necessary” procedures

» Ground ambulance disputes

• Examining key caselaw concerning ERISA and Medicare Advantage preemption

• Hypotheticals on complex reimbursement cases

• Practical tips on how to prevent escalation and reach resolution early

12:30 Networking Luncheon

check-square

microphone-alt

ESG AND DEI FOCUS SESSIONS

1:30 LIVE POLLING

What Every MCO Lawyer and Executive Needs to Know about ESG

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

Lindsey Fetzer, Partner, Bass, Berry & Sims

• 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

2:00

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

microphone-alt Brian Seaman, Counsel and Chief Diversity Officer, Stradley Ronon Stevens & 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

3:00

3:15

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

microphone-alt Elizabeth Bock, Partner, O’Melevny & Myers LLP

Alex Oliphant, Director, Berkeley Research Group

• 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

4:00

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

microphone-alt Tim McMichael, Deputy General Counsel – Director of Litigation, Premera Blue Cross

Adam 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

4:30

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

microphone-alt Kirk Nahra, Partner, WilmerHale

• 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

5:15 Cocktail Reception

MAIN CONFERENCE DAY TWO

THURSDAY, MARCH 30

8:00 Registration Opens

8:45

Co-Chairs’ Opening Remarks

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

Akure Paradis, Deputy General Counsel, CareSource

9:00

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

microphone-alt 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.

9:45

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

microphone-alt Jay Dewald, Partner, Norton Rose Fulbright

Brett Barnett, Partner, McGuireWoods LLP

Jed Wulfekotte, Partner, Crowell & Moring

• 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

10:30 Morning Coffee and Networking Break

10:45

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

microphone-alt Barbara Reeves, Arbitrator, Mediator, Special Master, JAMS

Emily Wey, Arbitrator and Mediator, Wey West Dispute Resolution

Elliot K. Gordon, Arbitrator, Mediator, and Special Master

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 to 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

11:30

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

microphone-alt MODERATOR: Benjamin McCoy, Partner, Fox Rothschild LLP

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

Jason Joffe, Partner, Squire Patton Boggs LLP

Matthew R. Varzally, Senior Legal Counsel, Litigation, CVS Health

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.

12:15 Networking Luncheon

Good event, moves at the right pace, good mix of plans and outside counsel.

The

Future of Mental Health Coverage, Access and Litigation

microphone-alt MODERATOR:

Kara Wheatley, Principal, Groom Law Group, Chartered

Heather D. Redmond, Deputy General Counsel, UnitedHealth Group

Jen Romano, Partner, Crowell & Moring LLP

Amanda G. Schreiber, Associate Senior Counsel, Cigna

Brad Lerner, Director, Public Policy, Elevance Health

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 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

2:30 Afternoon Coffee and Networking Break

3:00

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

microphone-alt Nicholas John, Associate Director, Berkeley Research Group, LLC

Mike Cowie, Partner, Dechert LLP

Joseph Miller, Partner, Mintz, Levin, Cohn, Ferris, Glovsky, and Popeo

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.

3:45

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

microphone-alt Devin Cohen, Partner, Ropes & Gray LLP

Private equity investment amidst health care 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

4:30 Conference Concludes

Venue:

THE METROPOLITAN CLUB OF CHICAGO

ADDRESS: 233 South Wacker Drive, Willis Tower, 67th Floor, Chicago, IL 60606-6304

Accommodation:

CANOPY CHICAGO

ADDRESS: 226 W Jackson, Chicago, IL 60606

PHONE: 1-800-HILTONS

American Conference Institute is pleased to offer our delegates a limited number of hotel rooms at a negotiated rate. To take advantage of these rates, please contact the hotel directly and quote “ACI – Managed Care Litigation and Dispute”

Please note that the guest room block cut-off date is February 28th, 2023. After that date OR when the room block fills, guestroom availability and rate can no longer be guaranteed.

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