14th Annual Advanced Forum on Managed Care Disputes and Litigations - WEB

EARN CLE CREDITS

ADVANCED FORUM ON

MANAGED CARE Disputes and Litigation

Be part of the only MCO-specific conference for the health care industry’s legal community.

May 2–3, 2024 | The Metropolitan, Chicago, IL

Engage with Top In-House Counsel from: • • •

Premera Blue Cross Inc. Humana AmeriHealth Caritas

• •

Elevance Health Health Alliance Plan

Government Insights from: Bindi R. Bhagat Antitrust Division Department of Justice Timothy Slattery Attorney Technology Enforcement Division, Federal Trade Commission (FTC) Supporting Sponsor

Distinguished Co-Chairs: Joanna Allen Senior Legal Counsel Elevance Health

Adam Petitt Partner Robinson & Cole LLP

What’s NEW for 2024: Angle-Right Special 15th Anniversary Panel with thought leaders from across the managed care industry who will provide insights, reflections, and predictions on litigation trends

Angle-Right Spotlight on Artificial Intelligence: DOJ and MCO insights on how to navigate regulation and litigation Angle-Right Ask an Arbitrator: An interactive Q&A on how arbitration decision makers are looking at your case Angle-Right Merger Guidelines: Understanding how new regulatory hurdles and an aggressive antitrust agenda will impact managed care deals

Angle-Right Bid Protests: Tracking trends in Medicaid procurement litigation

Associate Sponsors

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Tim McMichael Deputy General Counsel – Director of Litigation Premera Blue Cross

AmericanConference.com/ManagedCare • 888 224 2480

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American Conference Institute invites you to join us this Spring for the 15th Anniversary Edition of the Advanced Forum on Managed Care Disputes and Litigation.

Celebrate 15 Years of the Only MCO Specific Conference for the Healthcare Industry’s Legal Community

For the last 15 years, this forum has assembled the industry’s top litigators, leading plan counsel, and key government speakers to become a go-to meeting of the minds. The managed care industry considers this conference the most reliable source of analysis and strategic insights on how to mitigate legal risks and develop winning case strategies.

This year’s forum, taking place May 2–3, 2024, in Chicago will continue in this tradition with a program tailored to address the unique legal, regulatory, and policy challenges currently facing the managed care industry.

MCOs are tasked with navigating advancements in artificial intelligence and the exposure it creates, the impact of an aggressive antitrust enforcement agenda, and ever-evolving dispute resolution developments under the No Surprises Act. This program will address all these challenges and more.

Over two days, our all-star faculty will help you to sharpen your focus in these areas, and prepare for what’s to come in the litigation and adjacent landscape with sessions on: Angle-Right Legal challenges to the IDR under the No Suprises Act Angle-Right Critical steps for plans to take when dealing with financially distressed providers Angle-Right Takeaways from recent fraud and abuse investigations and enforcement activity in the healthcare industry Angle-Right Preparing for the next wave of health plan fee litigation Plus, don’t miss our interactive pre-conference workshop that will serve both novice and experienced litigators looking for a refresher on the ins and outs of ERISA in the managed care context.

Pre-Conference Workshop | Wednesday, May 1, 2024 1:00pm–4:30pm

The Evolution of ERISA: A Masterclass for Managed Care Litigators

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DISTINGUISHED SPEAKER FACULTY CO-CHAIRS

Joanna Allen Senior Legal Counsel Elevance Health Tim McMichael Deputy General Counsel – Director of Litigation Premera Blue Cross Adam Petitt Partner Robinson & Cole LLP SPEAKER FACULTY

Bindi R. Bhagat Antitrust Division Department of Justice Adam Cooke Partner Hogan Lovells LLP Mike Cowie Partner Dechert LLP Kevin Feder Partner O’Melveny & Myers Lindsey Fetzer Partner Bass Berry Sims PLC Christopher Flynn Partner Crowell & Moring LLP Jared R. Ginsberg Partner O’Melveny & Myers

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Jonathan Herman Managing Member Herman Law Kelly Hightower Hibbert Partner Crowell & Moring LLP Dan Howley Partner Rule, Garza, Howley LLP Elizabeth Hutchins Senior Managing Director, Disputes & Economics Ankura Kirstin Ives Co-Founder Falkenberg Ives LLP Christopher Keele, Esq. Mediator, Arbitrator JAMS Alexandra M. Lucas Partner Reed Smith LLP Tyler Marshall Associate Director BRG Benjamin McCoy Partner Fox Rothschild LLP Nate Moore Partner Robins Kaplan LLP

Lou Patalano Chief Legal Officer, Senior Vice President & Corporate Secretary Blue Cross and Blue Shield of Louisiana Chris Petelle Vice President and Associate General Counsel Humana Archana Rajendra Vice President and Deputy General Counsel Health Alliance Plan Henry Ford Health Barbara Reeves Arbitrator, and Mediator Jon Rose Senior Litigation Counsel HCA Matthew S. Rozen Partner Gibson, Dunn & Crutcher LLP Gregory Russo Managing Director BRG Hon. Myra C. Selby Partner Ice Miller Marguerita Brunson Sims Vice President, Deputy General Counsel AmeriHealth Caritas

AmericanConference.com/ManagedCare • 888 224 2480

Michelle Skipper Vice President American Arbitration Association Timothy Slattery Attorney Technology Enforcement Division, Federal Trade Commission (FTC) Katherine Strahan Partner Hunton Andrews Kurth LLP Ken Thomas Partner Fox Swibel Levin & Carroll LLP Ray Walker Managing Counsel – Litigation Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas Kara Petteway Wheatley Principal Groom Law Group, Chartered

Users

WHO YOU WILL MEET: In-House Counsel and Business Executives from Managed Care Organizations, HMOs, and Insurance Companies specializing in: • Litigation • Risk management • Claims/Strategic payments • Payor relations disputes

Outside Counsel specializing in: • Health plans • Health litigation • Managed care litigation • Managed care contracting • Payor disputes

Melissa Wong Partner Holland & Knight LLP

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PRE-CONFERENCE WORKSHOP WEDNESDAY, MAY 1

The level of expertise of both the speakers and attendees results in meaningful discussions and practical advice.”

1:00–4:30pm (Registration opens at 12:30pm)

The Evolution of ERISA: A Masterclass for Managed Care Litigators microphone-alt Eli Burriss, Partner, Katten Muchin Rosenman LLP Katherine Strahan, Partner, Hunton Andrews Kurth LLP The landmark legislation known as ERISA is set to turn 50 this year.

Join us as we mark ERISA’s continued significance in the managed care arena, with an interactive workshop that will start with the fundamentals before delving deeper into its applicability to MCOs, and its interaction with other areas of interest such as Medicaid and Medicare.

This is your opportunity to learn from leading ERISA litigators about the complexities and nuances of this law. They will help you formulate strategies that could save your client or organization millions by gaining a deeper understanding of this complex area. Build your knowledge, and develop your case strategy with these critical insights: • Overview of ERISA in the managed care context

• Minimizing legal exposure for an ERISA suit

» Examining the types of ERISA claims or causes of actions • Single plaintiff benefit claims to larger class action disputes • Understanding when provider state law claims are preempted by ERISA

• Analyzing the intersection of ERISA with Medicare and Medicaid • Exploring recent ERISA case law impacting the industry • Examining the latest PBM fee litigation

• Assessing the impact of the fiduciary exception on privilege

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Continuing Legal Education Credits EARN CLE 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.

hands-helping BECOME A SPONSOR With conferences in the United States, Canada, Latin America and Europe, 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

Questions about CLE credits for your state? Visit our online CLE Help Center at www.AmericanConference.com/Accreditation/CLE/

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DAY ONE

THURSDAY, MAY 2

• Examining Texas Medical Association challenges to provisions in the NSA and the implications for the IDR process moving forward » Exploring changes to fees, batching restrictions, QPA calculations

7:45

Registration Opens and Continental Breakfast Served

8:45

» How CMS is approaching QPA audits • Analyzing IDR outcomes for payors since the implementation of the process

Co-Chairs’ Opening Remarks microphone-alt Joanna Allen, Senior Legal Counsel, Elevance Health Tim McMichael, Deputy General Counsel – Director of Litigation, Premera Blue Cross Adam Petitt, Partner, Robinson & Cole LLP 9:00

15-Years of Managed Care: Reflections and Perspectives on How the Industry has Changed and Key Drivers in the Litigation Landscape microphone-alt Marguerita Brunson Sims, Vice President, Deputy General Counsel, AmeriHealth Caritas Gregory Russo, Managing Director, BRG Lou Patalano, Chief Legal Officer, Senior Vice President & Corporate Secretary, Blue Cross and Blue Shield of Louisiana Moderator: Tim McMichael, Deputy General Counsel – Director of Litigation, Premera Blue Cross Join renown litigators and thought-leaders from the managed care industry for an interactive discussion examining the most notable cases and developments of the last 15 years. Perhaps more importantly, panelists will discuss current forces shaping the landscape and what MCO’s and their counsel should be on the lookout for in the years ahead.

9:45

Examining the Latest Legal Challenges to the No Surprises Act and Key Takeaways for Payors from the IDR Process microphone-alt Alexandra M. Lucas, Partner, Reed Smith LLP Matthew S. Rozen, Partner, Gibson, Dunn & Crutcher LLP Ray Walker, Managing Counsel – Litigation, Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas The No Surprises Act came into effect in January of 2022. Two years later, it remains a moving target. The Texas Medical Association (TMA) successfully challenged several provisions in the regulations implementing the NSA. Most recently, and notably, they secured the TMA III decision that the QPA calculation requirements unfairly favored insurers. The Departments of Labor, and Health and Human Services have issued new proposed rules in response. This session will provide plans with insights on the impact of these decisions, how future rulemaking is shaping up, and trends in IDR provider strategies.

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• Reviewing federal and state enforcement of surprise billing laws

AmericanConference.com/ManagedCare • 888 224 2480

» Tracking how the process is performing to date in different states » Examining emerging plaintiff side strategies » Air ambulance litigation update on actions challenging IDR awards 10:45

Morning Coffee & Networking Break

SPECIAL FOCUS ON AI 11:00

MCOs on the Cutting Edge: How to Limit Exposure When Leveraging Artificial Intelligence, Algorithms and Emerging Technology microphone-alt Archana Rajendra, Vice President and Deputy General Counsel, Health Alliance Plan, Henry Ford Health Chris Petelle, Vice President and Associate General Counsel, Humana Kevin Feder, Partner, O’Melveny & Myers Moderator: Lindsey Fetzer, Member, Bass Berry & Sims PLC Artificial Intelligence holds the potential to generate critical insights and drive efficiencies across the healthcare system. As AI tools and related technologies become increasingly sophisticated, the MCOs and downstream entities that use them will need to develop a deep understanding of how to harness the power and the promise of these inventions—as well as the risks. Litigation is already starting to bubble up, making it important to examine the current regulatory environment, and exposure created by AI use.

• Monitoring how regulatory frameworks for the use of AI in healthcare are developing and the potential requirements and implications for payors • Identifying risks stemming from payors using AI and algorithms and resulting litigation to date » Analyzing claims of AI or AI assisted technology being used to ‘wrongfully’ deny coverage of health services » Assessing plaintiff claims of fraud and bad faith against insurers using AI » Addressing risks related to bias in AI models » Cyber security and privacy considerations • Conducting due diligence when selecting AI vendors » How plans should vet companies that use AI models to perform critical tasks like prior authorization • Exploring the potential for AI to be used in formulating legal arguments and predicting case outcomes a C5 Group Company Business Information in a Global Context

2:45

12:00

Antitrust Risks in an AI World: Assessing Whether Computer Determined Pricing at MCOs is Susceptible to Coordination microphone-alt Bindi R. Bhagat, Antitrust Division, Department of Justice Timothy Slattery, Attorney, Technology Enforcement Division, Federal Trade Commission (FTC) Moderator: Barbara Reeves, Arbitrator, Mediator, JAMS The FTC and DOJ recently shared concerns about the anticompetitive potential of AI. More specifically, the use of AI to aggregate data in a way that could result in collusion. This moderated discussion with enforcement agencies will flag areas of concern as it pertains to the use of AI/ML in managed care and the potential for anticompetitive outcomes.

12:30

Networking Lunch

Afternoon Refreshment Break

3:15

Bid Protests: Takeaways from the Medicaid Managed Care Procurement Litigation microphone-alt Benjamin McCoy, Partner, Fox Rothschild LLP The stakes are high when it comes to locking in a Medicaid managed care contract. For plans, a winning bid, can mean billions in state dollars. This has resulted in an increased emphasis on developing a winning bid strategy, and examining the procurement process and opportunities to challenge awards.

• Reviewing how many RFPs are active • Determining the average value of contracts • Tracking trends in contract awards and bid protests • Gaining insights from litigation challenging the procurement process 3:45

1:30

Preparing for a Surge in Health Plan Fee Litigation microphone-alt Christopher Flynn, Partner, Crowell & Moring LLP Kara Petteway Wheatley, Principal, Groom Law Group, Chartered Excessive fee claims are on the rise, targeting plans both big and small. It’s critical time to analyze causes of action and what plans/plan sponsors can do to protect themselves as they devise winning defense strategies.

• Examining litigation trends in excessive fee claim disputes target defendants » Review of three recent cases

Unpacking AHA V. Becerra and CMS Final Rule on 340B: Implications for MA Plans microphone-alt Melissa Wong, Partner, Holland & Knight LLP • Overview of Supreme Court ruling on AHA v. Becerra that invalidated CMS adjustments to Medicare Part B payment rates for drugs purchased by some hospitals under the 340B program • Examining how the CMS 340B Payment Policy Final Rule will impact hospital reimbursement under Medicare Part C • Determining repayment requirements for contracted and non-contracted 340B hospitals • Anticipating and preparing for ongoing disputes

» Lessons from retirement fee litigation

4:30

» Dissecting typical excessive fee litigation claims and common elements

Navigating A New Risk Adjustment Landscape: Key Regulatory and Legal Considerations for Plans in 2024

• Exploring disclosure requirements • Navigating service arrangements—litigation against health plan brokers and consultants • Anticipating excessive fee litigation: key considerations in preparation for the lawsuit before its filed 2:15

How to Strategically Manage Data and Analytics in Payor-Provider Disputes microphone-alt Elizabeth Hutchins, Senior Managing Director, Disputes & Economics, Ankura Adam Petitt, Partner, Robinson & Cole LLP

microphone-alt Tyler Marshall, Associate Director, BRG For MA plans, missteps when navigating the complexities of risk adjustment can be costly, making data accuracy and compliance of the utmost importance. In 2023 CMS introduced a new RA model and released the RADV final rule.

This session will delve into these developments, compliance best practices and the implications for the legal landscape.

5:00

Cocktail Reception Sponsored by

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DAY TWO

FRIDAY, MAY 3

7:45

This has historically been the best conference in Managed Care.”

Registration Opens and Continental Breakfast Served

8:50

Co-Chairs’ Opening Remarks microphone-alt Joanna Allen, Senior Legal Counsel, Elevance Health

• Identifying EBSA enforcement priorities including prior authorization requirements, network adequacy and reimbursement rates • Overview of recent, notable EBSA actions protecting mental health and substance use disorder benefits • Analyzing deficiencies in NQTL analyses and examples of corrections by plans to come into compliance under the Consolidated Appropriations Act

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

10:30

Adam Petitt, Partner, Robinson & Cole LLP

10:45

Morning Coffee and Networking Break

GC Perspectives on Improving Payor-Provider Relationships

9:00

Fraud and Abuse: MCO Takeaways from Recent Investigations and Enforcement Activity in the Healthcare Industry microphone-alt Kelly Hightower Hibbert, Partner, Crowell & Moring LLP Jared R. Ginsberg, Partner, O’Melveny & Myers Nate Moore, Partner, Robins Kaplan LLP • Analyzing how the U.S. ex rel. Schutte v. SuperValu Inc. decision will impact the FCA defense landscape for MCOs • Examining the latest kickback schemes involving providers and labs and how they are impacting MCOs » Assessing the AKS enforcement landscape involving government programs and commercial plans » Implications of the circuit split on FCA based on AKS • Identifying trends in fraudulent billing that MCOs need to watch » Telehealth, genetic testing • Exploring lessons learned for MCOs from notable criminal and civil actions taken by the DOJ • Spotlight on investigations into mental health and addictions services » Uncovering schemes involving sober living homes 10:00

A New Era of MHPAEA Enforcement: Litigation Risks and Compliance Considerations for MCOs MHPAEA enforcement is ramping up and the Biden administration has proposed new rules that would strengthen federal laws on mental health parity requirements. The proposal would require health plans to collect data to assess the impact of “nonquantitative treatment limits” (NQTLs) on mental and behavioral health benefits and medical and surgical services. It’s a critical time for MCOs to examine what’s being proposed by regulators, as well as recent enforcement actions so that they can remove problematic provisions and ensure future compliance.

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microphone-alt Tim McMichael, Deputy General Counsel – Director of Litigation, Premera Blue Cross Jon Rose, Senior Litigation Counsel, HCA Moderator: Jonathan Herman, Managing Member, Herman Law Firm Hear from both sides of the aisle during this interactive discussion exploring payor provider perspectives. Panelists will offer insights on trends in the type of disputes that are arising in the MCO arena and best practices for building better relationships in an effort to avoid or at the very least efficiently manage what can often be protracted, costly matters for all involved.

INTERACTIVE PANEL & Q&A 11:30

Ask an Arbitrator About Managed Care Disputes: Everything You Ever Wanted to Know but Have Been Afraid to Ask microphone-alt Kirstin Ives, Co-Founder, Falkenberg Ives LLP Christopher Keele, Esq., Mediator, Arbitrator, JAMS Hon. Myra C. Selby, Partner, Ice Miller Moderator: Michelle Skipper, Vice President, American Arbitration Association • Examining emerging challenges in arbitration and trends in payor-provider disputes » Determining the type of disputes best handled in arbitration » To what extent is arbitration final and binding • Identifying what makes a persuasive claim or defense from the perspective of experienced arbitrators • Avoiding lesser-known pitfalls in the process in order to maximize your chances of obtaining a favorable decision • Exploring how best to structure arbitration for an efficient resolution a C5 Group Company Business Information in a Global Context

12:30

Networking Lunch

1:30

A MCO Guide to Navigating Mergers and Acquisitions Amid Heightened Antitrust Enforcement microphone-alt Mike Cowie, Partner, Dechert LLP Dan Howley, Partner, Rule, Garza, Howley LLP The Biden Administration is hyper focused on antitrust in healthcare. In the past few years the DOJ and have challenged several significant deals, with mixed success. New merger guidelines reflect a willingness to investigate or challenge more deals.

• Tracking the antitrust impact of expansion into new areas, such as physician services, hospital related services, and home healthcare in the healthcare industry • Understand what regulators look for in assessing a proposed health plan merger and how to prepare for and respond to antitrust scrutiny

3:00

Limiting Liability When a Data Breach Occurs: Lessons Learned from Recent Incidents Impacting Plans and Downstream Partners microphone-alt Adam Cooke, Partner, Hogan Lovells LLP • Monitoring class action activity for data privacy breaches » Examining trends in the type of claims coming out of data breaches against plans and vendors • Improving breach responsiveness and limiting liability with lessons learned from recent cases » Identifying plan counsel and outside counsel remediation action points • Assessing and managing future risks arising from data trackers on websites and other emerging areas of risk for consideration including artificial intelligence 3:45

Top 5 Legal Considerations for MCOs when Dealing with Financially Distressed Providers

» Developing an effective internal and external communication strategy to avoid problematic language that could impact the deal

microphone-alt Ken Thomas, Partner, Fox Swibel Levin & Carroll LLP

» Examples of documents in proposed plan mergers that impacted decision making by government authorities

There has been an uptick in healthcare provider bankruptcies in the last couple year. Providers claim the roll back of COVID-19 funding and implementation of the No Surprises Act have contributed to the financial strain, and ultimately the decision to file for Chapter 11 bankruptcy.

• Examining what’s new in the HSR process • Anticipating the impact of federal draft merger guidelines on future deals involving MCOs • Analyzing recent deals that received scrutiny, including DOJ challenges to MCO deals that were unsuccessful » CVS acquisition of Oak Street, Signify Health » UnitedHealth and Change Healthcare case • Explore how payors manage concerns about channel conflict in the context of vertical integration 2:30

Afternoon Break

For payors, it’s a critical time to assess the impact on current business with providers and strategically approach ongoing legal matters.

• Examining key lessons coming out of the Envision bankruptcy and lawsuits • Conducting business with a provider in bankruptcy – when do you need bankruptcy court approval » Assessing how your provider agreement is impacted under such circumstances • 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 4:15

Conference Concludes

C5 celebrates 40 years of excellence! We are thrilled to have provided exceptional conference experiences globally with our outstanding team, speakers, sponsors, partners, and attendees. To mark this milestone, we're launching a new logo which represents our commitment to innovation, growth, and excellence, represented by the five Cs of C5: Current, Connected, Customer-Centric, Conscientious, and Committed.

Looking back on 40 years, we are grateful for our achievements—hosting global conferences, uniting industry leaders, and supporting business growth. However, we are not done yet! We are committed to pushing boundaries and creating impactful experiences and we're excited for the next 40 years of success.

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