12th Annual Advanced Forum on Managed Care Disputes and Litigation - WEB by C5Group

Bringing the in-person conference experience to you virtually! Details on pg. 2

June 9–10, 2021 (CDT) | Virtual Conference 12 TH ANNUAL ADVANCED FORUM ON

MANAGED CARE Disputes and Litigation Be part of the only MCO-specific conference for the health care industry’s legal community Distinguished Co-Chairs: Timothy McMichael Assistant General Counsel – Director of Litigation and Special Investigations Unit Premera Blue Cross Caroline Schiff Assistant General Counsel, Litigation and Investigations Humana Inc.

EARN CLE CREDITS

Focus on Health Care Antitrust and the Implications for Managed Care Alex Bryson Attorney, Mergers IV Federal Trade Commission Karl Knutsen Attorney, Antitrust Division U.S. Department of Justice

Lumi Nodit Assistant Attorney General Washington Attorney General’s Office Antitrust Division Abigail Wood Deputy Attorney General, Antitrust Section Pennsylvania Attorney General's Office

New Sessions for 2021 will Explore:

Engage with Senior Industry Leaders from:

» The Status of ACA and How to Prepare for A New Regulatory Regime Under the Biden Administration

» Blue Cross Blue Shield of Texas

» Kaiser Family Foundation

» Cigna

» Molina Healthcare

» Affirmative Cost Recovery: How plans should approach litigation against third parties

» Henry Ford Health System and Health Alliance Plan of Michigan

» Premera Blue Cross

» How to Navigate Healthcare Provider Bankruptcy » Identifying and Preventing Telehealth-related Disputes

ASSOCIATE SPONSORS:

AmericanConference.com/ManagedCare • 888 224 2480

» Humana Inc.

» Scott and White Health Plan

EXHIBITOR:

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The rollout of the new administration’s healthcare and enforcement priorities Managed Care organizations combined with transparency measures, surprise billing legislation and pressure and their counsel will need from the pandemic is churning up a new set of challenges and potential risks. to stay nimble in the coming ACI’s 12th Annual Advanced Forum on Managed Care Disputes and Litigation will year to prepare for and help you make sense of these developments, and their profound impact on MCOs. respond to the torrent of On June 9–10, 2021, join us for an unparalleled learning experience, delivered by an esteemed line-up of in-house lawyers and outside counsel dedicated to sharing practical change moving through the insights on how to protect your organization. healthcare industry.

At this comprehensive conference, you will have the opportunity to engage in advanced conversations on: CHEVRON-DOUBLE-RIGHT Preparing for and protecting against telehealth reimbursement disputes CHEVRON-DOUBLE-RIGHT The latest fraud and antitrust actions

CHEVRON-DOUBLE-RIGHT Post-pandemic risk adjustment CHEVRON-DOUBLE-RIGHT Best practices for affirmative cost recovery

Interactive Virtual Conference Experience This program is designed to bring the dynamic, in-person conference experience to you virtually with multiple ways to engage with speakers, stay connected with industry peers and expand your professional network through 1-on-1 conversations. Virtual Networking Opportunities Take advantage of 1:1 speed networking, exhibit hall meetups and direct video chats with fellow conference participants.

Polling

Virtual Speaker Meet and Greets Come camera ready and engage in an interactive roundtable discussions. Take advantage of the opportunity to meet our speakers face-to-face, ask targeted questions, receive real time answers and share your own thoughts on pressure points and challenges.

Weigh in and seize the opportunity to benchmark with industry peers in real-time on leading issues such as sensitive, complex hypothetical scenarios.

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Co-Chairs Timothy McMichael Assistant General Counsel – Director of Litigation and Special Investigations Unit Premera Blue Cross Caroline Schiff Assistant General Counsel, Litigation and Investigations Humana Inc.

Distinguished Speaker Faculty Peggy Beat Lawyer Axiom Alex Bryson Attorney, Mergers IV Federal Trade Commission Eliot Burriss Partner Holland & Knight LLP Mike Cowie Partner Dechert LLP Max Czernin Partner Squire, Patton, Boggs LLP

Michael Kolber Partner Manatt, Phelps & Phillips LLP David E. Kopans Of Counsel Jones Day Ashlee Knuckey Partner Locke Lord LLP Deepti A. Loharikar Director of Regulatory Affairs Association for Behavioral Health and Wellness J. Gabriel McGlamery Senior Health Care Policy Consultant, Government Relations Florida Blue Richard J. Merino Senior Managing Director Ankura Consulting Group Peter Mucchetti Partner Clifford Chance US LLP MaryBeth Musumeci Associate Director, Program on Medicaid and the Uninsured Kaiser Family Foundation

Jacob T. Elberg Former Federal Prosecutor; Professor Seton Hall School of Law

Lumi Nodit Assistant Attorney General Washington Attorney General’s Office Antitrust Division

Brandie Gasper Senior Assistant General Counsel Molina Healthcare

Akure Paradis Deputy General Counsel CareSource

Kirstin Ives Partner Falkenberg Ives LLP

Lou Patalano Chief Legal Officer, Corporate Vice President & Corporate Secretary Sentara Healthcare & Optima Health

Beatriz Jaramillo Senior Counsel Humana Inc. Jerome Kearns Director of Regulatory Compliance, Medicaid and Medicare Compliance Officer Horizon Blue Cross Blue Shield of New Jersey Karl Knutsen Attorney, Antitrust Division U.S. Department of Justice

James E. Peacock Vice President and General Counsel Scott and White Health Plan Adam J. Petitt Partner Stradley Ronon Stevens & Young, LLP Preston L. Pugh Partner Crowell Moring LLP

AmericanConference.com/ManagedCare • 888 224 2480

Archana Rajendra Senior Counsel Henry Ford Health System and Health Alliance Plan of Michigan Tony Rodriguez Vice President & Assistant General Counsel Kaiser Foundation Hospitals/ Health Plan Jon Rose Senior Litigation Counsel HCA Healthcare Layna Rush Shareholder Baker Donelson Michelle Skipper Vice President American Arbitration Association Jennifer Sucher Partner Fox Swibel Levin & Carroll LLP Thomas Sullivan Partner Shook Hardy Bacon LLP Ursula Taylor Founding Partner The Law Offices of Ursula Taylor LLC

hands-helping B ECOME 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

EARN CLE CREDITS

Viktoriya Torchinsky-Field VP Chief Counsel, Litigation Cigna

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.

Matthew Varzally Senior Associate General Counsel Blue Cross Blue Shield of Texas

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

Raymond Walker Managing Counsel Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas Abigail Wood Deputy Attorney General, Antitrust Section Pennsylvania Attorney General's Office Jeff Joseph Wurzburg Senior Counsel Norton Rose Fulbright US LLP

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. For more information on ACI’s CLE process for virtual events visit: www.americanconference.com/ accreditation-instructions-for-virtualattendance/

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day 1 June 9, 2021 (CDT) 8:45

10:45

Opening Remarks from the Co-Chairs

Anticipating the Future Implications of COVID-19 for Managed Care

Microphone Timothy McMichael, Assistant General Counsel – Director of Litigation and Special Investigations Unit, Premera Blue Cross

Caroline 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 Microphone MaryBeth Musumeci, Associate Director, Program on Medicaid and the Uninsured, Kaiser Family Foundation

Microphone Ashlee Knuckey, Partner, Locke Lord LLP

Lou Patalano, Chief Legal Officer, Corporate Vice President & Corporate Secretary, Sentara Healthcare & Optima Health

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?

• 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

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

9:30

In-House Counsel Roundtable: The Most Pressing Legal and Operational Challenges for the Managed Care Industry in 2021 Microphone Jerome Kearns, Director of Regulatory Compliance, Medicaid and Medicare Compliance Officer, Horizon Blue Cross Blue Shield of New Jersey

Akure 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

• Explore the top priorities for legal and compliance teams at leading MCOs » Exploring how plans are managing the impact of COVID from budgetary pressures to preparing for emerging litigation • Learn about how insurers are preparing for potential shifts in the healthcare landscape under the new administration • Engage in dialogue about in-house departmental structures and viewpoints on working with outside counsel • Analyze challenges stemming from the CMS interoperability act information sharing requirements with members and providers and how to address them 10:30 | Break

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SPOTLIGHT ON LEGISLATIVE DEVELOPMENTS 12:30

Assessing the Impact of Pricing Transparency Legislation Implementation on Managed Care Networks Microphone Peggy Beat, Lawyer, Axiom

Archana Rajendra, Senior Counsel, Henry Ford Health System and Health Alliance Plan of Michigan

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

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1:15

3:45 | Break

Status Report on Surprise Billing Legislation Microphone 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

4:15

Cyber Security and Privacy Practices to Protect Patient Data and Mitigate Litigation and Regulatory Risk Microphone Timothy McMichael, Assistant General Counsel – Director of Litigation and Special Investigations Unit, Premera Blue Cross

Layna Rush, Shareholder, Baker Donelson

• 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

2:00

Building Better In-House and Outside Counsel Relationships: Industry Best Practices and Ethical Considerations

How Health Insurers Should Approach Telehealth Microphone Eliot Burriss, Partner, Holland & Knight LLP

Microphone James Peacock, Vice President and General Counsel, Scott and White Health Plan

David E. Kopans, Of Counsel, Jones Day

Brandie Gasper, Senior Assistant General Counsel, Molina Healthcare

Viktoriya Torchinsky-Field, VP Chief Counsel, Litigation, Cigna

Jonathan Herman, Partner, Herman Law Offices

• 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

• 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

3:00

Risk Adjustment: How to Navigate the Regulatory and Litigation Landscape During the Pandemic Microphone J. Gabriel McGlamery, Senior Health Care Policy Consultant, Government Relations, Florida Blue

• Understanding the licensing parameters and how the scope of practice is being expanded at the state level

• 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

Michael 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

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day 2 June 10, 2021 (CDT) SPECIAL FOCUS ON ANTITRUST

9:00

Opening Remarks from the Co-Chairs Microphone Timothy McMichael, Assistant General Counsel – Director of Litigation and Special Investigations Unit, Premera Blue Cross

Caroline Schiff, Assistant General Counsel, Litigation and Investigations, Humana Inc.

9:15

Behavioral Health and Alternative Therapies: Emerging Considerations for Scope of Coverage Microphone Deepti A. Loharikar, Director of Regulatory Affairs, Association for Behavioral Health and Wellness

Thomas Sullivan, Partner, Shook Hardy Bacon LLP

• 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 Microphone Jacob T. Elberg, Former Federal Prosecutor; Professor, Seton Hall School of Law

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.

11:30

Addressing Anti-Competitive Terms in Payor-Provider Contracts Microphone moderator: Mike Cowie, Partner, Dechert LLP

Abigail Wood, Deputy Attorney General, Antitrust Section, Pennsylvania Attorney General's Office

Karl Knutsen, Attorney, Antitrust Division, U.S. Department of Justice

This panel will discuss ongoing developments in antitrust affecting the managed care arena with an aim to spotting and avoiding problematic contract terms. We will hear from enforcers at the U.S. Justice Department and the California Attorney General’s Office and engage in a dialogue about: 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 Microphone Alex Bryson, Attorney, Federal Trade Commission

Peter Mucchetti, Partner, Clifford Chance US LLP

Lumi Nodit, Assistant Attorney General, Washington Attorney General’s Office, Antitrust Division

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

11:10 | Break

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1:45

3:30 | Break

Affirmative Cost Recovery: How Plans Should Approach Litigation Against Third Parties

3:45

Microphone Matthew Varzally, Senior Associate General Counsel, Blue Cross Blue Shield of Texas

Kirstin Ives, Partner, Falkenberg Ives LLP

moderator: Caroline 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

2:30

Payor-Provider Litigation Landscape: Managing Disputes Involving Contracted and Non-Par Providers Microphone 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

MEDIA PARTNERS:

Microphone 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 Contract Terms and Purchaser Liability

» When to include co-plaintiffs

Examining the Latest Litigation Against PBMs

Microphone 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

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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 35 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.

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