13th Annual Advanced Forum on Managed Care Disputes and Litigation - WEB by C5Group

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13 TH ANNUAL ADVANCED FORUM ON

MANAGED CARE Disputes and Litigation

The only conference designed specifically for MCOs and their Counsel! March 30 – 31, 2022 • The Metropolitan Club, Chicago + Livestream Option

EARN CLE CREDITS

2022 Program Highlights

Distinguished Co-Chairs Viktoriya Torchinsky-Field VP Chief Counsel Cigna Denise Zamore Deputy General Counsel Optum

Special Fireside Chat Marianne Short EVP, General Counsel UnitedHealth Group

Government Faculty

CHEVRON-RIGHT Focus Session on the “No Surprises Act” and how it will change managed care from the perspectives of payors, patients, and providers CHEVRON-RIGHT Spotlight on the rise of antitrust enforcement – how health insurers and providers can mitigate the risks and effectively plan for vertical integration CHEVRON-RIGHT Special California Session: What MCOs need to know about Golden State Standards and the implications for the rest of the nation CHEVRON-RIGHT Think tank on key contractual considerations for value-based agreements between payors and providers CHEVRON-RIGHT In-Depth discussion and analysis on new and emerging coverage considerations on Social Determinants of Health and Promoting Health Equity

Megan Tinker Assistant Inspector General Office of Audit Services HHS Office of Inspector General Sarah Ream Chief Counsel California Department of Managed Care

Reconnect in-person with In-House Counsel from: • Anthem

• Henry Ford Health System and Health Alliance Plan of Michigan

• Priority Health

• Humana

• Cigna

• Premera Blue Cross

• UnitedHealth Group

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

Supporting Sponsors

Associate Sponsors

AmericanConference.com/ManagedCare • 888 224 2480

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A shifting political climate, proposed regulatory changes, pandemic-related claims, behavioral health coverage considerations, and the risks presented by an increasingly digital business environment have created fertile ground for managed care related disputes and litigation. MCO’s will be watching the Biden Administration closely in 2022, in anticipation of increased scrutiny, and enforcement in the antitrust and FCA arenas. Meantime, the No Surprises Act has ushered in new requirements for payors and providers, including an independent dispute resolution process. It’s a critical time to come together to analyze the latest and greatest challenges facing managed care organizations and shaping the litigation landscape. ACI’s 13th Annual Advanced Forum on Managed Care Disputes and Litigation, is back live and in-person in Chicago this Spring, with an outstanding speaker faculty comprised of leading in-house and outside counsel. Hear the timely, practical, legal insights that will help your organization develop strategies to mitigate risk and achieve favorable business outcomes. We hope you will join us at the only MCO-focused conference in the country for an unparalleled learning experience.

Afternoon Comments-alt Interactive Breakouts HANDS

EQUALS

Engage in meaningful dialogue about diversity, equity, and inclusion initiatives for in-house and outside counsel.

\ In-house counsel for the managed care industry responsible for: » Litigation » Risk management » Claims/strategic payments » Provider relations and disputes \ Law firm attorneys practicing in: » Healthcare and health insurance » Healthcare/managed care litigation

COMPLIMENTARY SESSION RECORDING

Watch a free session recording from our 2021 conference on Assessing the Impact of Pricing Transparency Legislation Implementation on Managed Care Networks.

Litigation and Enforcement Sessions Addressing: • Behavioral Health Claims • Payor- Provider Litigation • COVID-19-Related Disputes

Strong speakers and content. I enjoy this conference every year. First time attendee and pleased with the material and presentations.

2 | #ACIManagedCare

A Must-Attend  Event For:

• Fraud and Abuse Activity Related to Medicaid and Medicare Managed Care Plans

The level of expertise of both the speakers and attendees results in meaningful discussions and practical advice. Good event, moves at the right pace, good mix of plans and outside counsel.

PLAY

I enjoyed every panel…very relevant topics and PRACTICAL ADVICE. This has historically been the best conference in Managed Care.

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Distinguished Faculty

Mike Cowie Partner Dechert, LLP Kimberly J. Donovan Partner

Squire, Patton, Boggs

CO-CHAIRS Viktoriya Torchinsky-Field VP Chief Counsel Cigna

Melinda J. Dutton Partner Manatt, Phelps & Phillips, LLP

Denise Zamore Deputy General Counsel Optum

Kellen Dwyer Partner Alston & Bird LLP

SPEAKERS

Amanda L. Genovese Counsel O’Melveny & Myers LLP

Bradley Lerner Director Public Policy, Manager, Behavioral Health and Enterprise Issues Anthem Inc. Brian Lichter VP Stroz Friedberg Ben McCoy Partner Fox Rothschild LLP Tim McMichael Assistant General Counsel – Director of Litigation/SIU Premera Blue Cross

Sara Goldfarb Senior Legal Counsel, Litigation Aetna

Joseph M. Miller Member, Co-chair, Antitrust Practice Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

Inbal Hasbani Senior Counsel Cigna

Alex Oliphant Director BRG

Elizabeth M. Bock Partner O’Melveny & Myers LLPg

Jonathan Herman Partner Herman Law

Akure Paradis Deputy General Counsel

Eli Burriss Partner Katten, Muchin, Rosenman

Ashlee Knuckey Partner Locke Lord LLP

James Cash Senior Counsel Humana

David Kopans Of Counsel Jones Day

Adam Petitt Partner Stradley Ronon Stevens & Young LLP

Selina Coleman Partner Reed Smith

Kathy Kottos Senior Associate Counsel Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

Ed Baker Of Counsel Constantine Cannon Liz Brady Interim Co-Director, Antitrust Division Florida Office of Attorney General

Sarah Ream Chief Counsel California Department of Managed Care

Geoffrey Sigler Partner Gibson Dunn Marianne D. Short Executive Vice President UnitedHealth Group Marguerita Brunson Sims Senior Counsel CareSource Peter D. St. Phillip, Jr. President and Head of Litigation Lowey Dannenberg, PC Megan Tinker Assistant Inspector General Office of Audit Services HHS Office of Inspector General Ray Walker Managing Counsel – Litigation Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas Tiffany Wandy Executive Director, Clinically Integrated Network LifeBridge Health Paul Weller Partner Robins Kaplan LLP JoAnna Younts Director BRG

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

requirements. This course is identified as nontransitional for the purposes of CLE accreditation.

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.

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

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

Brian P. Seaman Counsel and Chief Diversity Officer Stradley Ronon & Young LLP

Accreditation will be sought in those jurisdictions requested

EARN CLE by the registrants which have continuing education CREDITS

CareSource

Matt Ryan Senior Managing Director, Disputes & Economics Ankura

AmericanConference.com/ManagedCare • 888 224 2480

For more information on ACI’s CLE process visit: https://www.americanconference.com/accreditation

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Day One • Wednesday, March 30, 2022 7:45

Registration & Breakfast

8:45

Co-Chairs’ Opening Remarks microphone-alt Viktoriya Torchinsky-Field, VP Chief Counsel, Cigna Denise Zamore, Deputy General Counsel, Optum 9:00

IN HOUSE HOT TOPICS

Examining How the Latest Industry Trends, Challenges, and Opportunities are Shaping In-House Priorities and Responsibilities MODERATOR

microphone-alt Denise Zamore, Deputy Counsel, Optum 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 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 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

• • • •

• 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 microphone-alt Mike Cowie, Partner, Dechert LLP Joseph Miller, Partner, Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C. Liz Brady, Interim Co-Director, Antitrust Division, Florida Office of Attorney General 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 MODERATOR:

10:00

Fireside Chat on the Managed Care Industry 2022 and Beyond

microphone-alt Matt Ryan, Senior Managing Director, Disputes & Economics, Ankura

MODERATOR

Adam J. Petitt, Partner, Stradley, Ronon, Stevens & Young LLP

Marianne Short, EVP, General Counsel, UnitedHealth Group

Paul Weller, Partner, Robins Kaplan LLP

microphone-alt Viktoriya Torchinsky-Field, VP Chief Counsel, Litigation, Cigna 10:30

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.

Break

10:45

Anticipating the Impact of the No Surprises Act on Payors and Health Care Providers microphone-alt JoAnna Younts, Director, BRG Archana Rajendra, Senior Counsel, Henry Ford Health System and Health Alliance Plan of Michigan

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Geoff Sigler, Partner, Gibson Dunn

2:00

CASE STUDY

Litigating Behavioral Health Claims: The Biggest Wins, Losses, and Future Considerations for Payors microphone-alt Bradley Lerner, Director, Public Policy, Manager, Behavioral Health and Enterprise Issues, Anthem

Ben McCoy, Partner, Fox Rothschild LLP

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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 » Pleading Stage Strategies – An overview of the pleading standards that have emerged for Parity Act claims and tactics to for motions to dismiss » How to approach coverage for residential treatment centers, and wilderness treatment therapy claims » Analysis of new theories being raised under the Parity Act and important cases to monitor • Emerging issues stemming from the use of telemedicine for mental health • Litigation Challenging Coverage Exclusions – An overview of the current precedent concerning Parity Act challenges to coverage exclusions and defenses to raise • Review of Litigation Involving Guidelines – A discussion of Wit v. United Behavioral Health and ongoing litigation involving challenges to internal guidelines 2:45

Break

3:00

Legal Landmines for MCOs in the Digital Landscape and How to Avoid Them microphone-alt David Kopans, Of Counsel, Jones Day LLP • 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 2:45

INTERACTIVE BREAKOUT DISCUSSIONS

Comments-alt How to Define, Assess and Improve DEI in All Aspects of the Business HANDS

EQUALS

microphone-alt Brian Seaman, Partner, Stradley, Ronon, Stevens & Young LLP 4:30

How to Navigate Client Expectations: The Top Dos, Donts, and Ethical Considerations for In-House and Outside Counsel microphone-alt Sara Goldfarb, Senior Legal Counsel, Litigation, Aetna Jonathan Herman, Partner, Herman Law Akure Paradis, Deputy General Counsel, CareSource Kimberly J. Donovan, Partner, Squire, Patton, Boggs • Ethical considerations for both in-house counsel and outside counsel in dealing with their respective clients • Developing effective budgets • How to set and manage expectations: top dos and donts 5:30

wine-glass Cocktail Reception Sponsored by REGISTER NOW

AmericanConference.com/ManagedCare • 888 224 2480

Day Two • Thursday, March 31, 2022 7:45

Registration & Breakfast

8:45

Co-Chairs’ Opening Remarks 9:00

Fraud and Abuse: Tracking the Latest in Medicare and Medicaid Related Enforcement and What it Means for Payors Moving Forward microphone-alt 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 microphone-alt 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 MODERATOR:

microphone-alt Amanda Genonvese, Counsel, O’Melveny & Myers LLP Tim McMichael, Assistant General Counsel, Director of Litigation/SIU, Premera Blue Cross Eli Burriss, Partner, Katten Muchin Rosenman LLP Ashlee Knuckey, Partner, Locke Lord 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

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11:45

2:45

How MCOs Should Approach Value-Based Contracts microphone-alt Tiffany Wandy, Executive Director, Clinically Integrated Network, LifeBridge Health Selina Coleman, Partner, Reed Smith LLP • 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

3:00

Affirmative Litigation Against Drug Manufacturers: Focus on “ Pay-for-Delay” Antitrust Claims and Other Recovery Opportunities for Managed Care Organizations microphone-alt James Cash, Senior Counsel, Humana Kathy Kottos, Senior Associate Counsel, Blue Cross Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas

• Anticipating disputes related to value-based arrangements 12:30

Break

Networking Lunch

Peter D. St. Phillip Jr., Partner, Head of Litigation, Lowey Dannenberg

1:30

Social Determinants of Health and Promoting Health Equity: New and Emerging Coverage Considerations in Support of Improved Health Outcomes and the Business

• 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 data

microphone-alt 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 2:00

Medical Loss Ratio Compliance and Enforcement Considerations for MCOs

• Expected discovery burdens • Assessing concerns over positional conflicts – are they valid? • Top settlement considerations 4:00

Cyber Security, Privacy and Ransomware: Critical Steps to in the 24-Hours Following a Data Breach microphone-alt Brian Lichter, VP, Stroz Friedberg Kellen Dwyer, Partner, Alston & Bird

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

• How to revamp company policies to comply with privacy regulations pertaining to the transfer of digital health information

Alex Oliphant, Director, BRG This session will cover: • Defining Medical Loss Ratio (MLR), the history of MLR reporting and enforcement, and the risks associated with MLR submissions

• 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

• 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

• Everything you have wanted to know about ransomware attacks and how to formulate an effective response strategy

• Examining the legal risks posed when submitting MLR data and what steps can be taken to mitigate those risks

5:00

Conference Concludes

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Planning Ahead for Live Conferences: C5’s All Secure Safety Plan As American Conference Institute and our partners plan for in-person events, we are committed to building and enhancing the planning and preparation with a view to offering our guests a safe place for live conference delivery. In addition, to ensure your safety, our event staff is fully vaccinated. All our events will adhere to official government and local authority guidance in addition to venue or location-specific regulations, and will follow the commitments below.

In-person Conference Participation Requirements For the protection and wellbeing of all event attendees, we have implemented a vaccination requirement for entry into the conference. All attendees and staff are required to provide proof of being fully vaccinated with a COVID-19 vaccine. A negative COVID-19 test result will not qualify for entry into the conference. Vaccination proof must be accompanied with a government-issued ID.

Attendance Screening All attendees will need to assert that at the time that they first attend the conference and for the 14 days prior: y They are not experiencing COVID-19 symptoms. y Have not traveled from an area under a travel health advisory. y Have not provided care for or had close contact with any person with or reasonably suspected of having COVID-19, or with any person who traveled outside of your home country or to an area under a travel health advisory. y Have not been advised by any health authority, government agency or regulation to selfisolate due to possible exposure to COVID-19. Link to COVID-19 symptoms: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html We are closely monitoring industry best practices and will be evaluating further additional measures pertaining to vaccinations and on-site screening based on the advice of health authorities.

As per the guidance of the CDC, and the updated mask mandate that has been put in place by local government officials, masks are now required in all indoor public venues and businesses except while eating and drinking. We reserve the right to deny entry to anyone not following the requirements above. Please note our entry policy is subject to change at any time based on changing local regulations.

Enhanced Communication y Advance communication to all attendees on what to expect and prepare for at the conference: from registration to conference materials to room layout to food and beverage options and more. y Education and training for the team to ensure we provide a safe and secure conference experience. y Distribution of local health-resource information in advance of the event. y Ongoing communication and advance planning with the venue regarding enhanced cleaning and sanitizing measures, response strategies and other onsite protocols.

Increased Cleaning and Sanitation y Placement of hygiene stations throughout the conference including the registration area, meeting spaces and high frequency areas. y Availability of personal hygiene and safety products including facial coverings where available.

Safety and Physical Distancing y Physical distancing protocols such as limiting attendance, directional signage and markers throughout the conference.

Reduced Touchpoints

y A conference room layout with planned seating for appropriate physical distancing.

y Reduction of the physical distribution of onsite materials.

y We continue to work closely with our venue partners to ensure the safety of our attendees. Please check back frequently as we monitor and evolve our plan in the weeks ahead.

y Food and beverage options that ensure minimal handling and exposure.

AmericanConference.com/ManagedCare • 888 224 2480

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If you choose to attend via livestream you can expect true interaction virtually — from start to finish.

Emma McAdam VP, Government Affairs

If you are unable to attend for any reason, you will have the following options:

Janet Smith VP, General Counsel

Olivia Thomson Chief Compliance Officer

Luis Santos Director

y A full credit note for you, or a colleague to attend another event.

Contact our customer service team at 1-888-224-2480 or customerservice@americanconference.com to learn more about this option.

Ramesh Kumar Partner

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y A full refund.

Distinguished Co-Chairs

All cancellations and changes must be submitted to customerservice@americanconference.com by March 20.

Viktoriya Torchinsky-Field VP Chief Counsel, Litigation Cigna

Denise Zamore Deputy General Counsel Optum

Special Fireside Chat

Patricia Harden Head of Sanctions Miyuki Johnson VP, Manufacturing

Marianne Short EVP, General Counsel UnitedHealth Group

American Conference Institute is pleased to offer our delegates a limited number of hotel rooms at a negotiated rate. Both hotels are located in the same historic building across the street from the meeting venue. To take advantage of these rates, please contact the hotel directly and quote “American Conference Institute”. Reservations: 1-800-HILTONS Hotel: Address: Rate:

Hilton Garden Inn Chicago Central Loop 245 South Franklin, Chicago, IL 60606 $139/night + tax

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Please note that the guest room block cut-off date is March 8, 2022. After that date OR when the room block fills, guestroom availability and rate can no longer be guaranteed.

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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.

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