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

Engage with Top In-House Counsel from:

• Premera Blue Cross Inc.

• Humana

• AmeriHealth Caritas

ADVANCED FORUM ON

MANAGED CARE

Disputes and Litigation

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

• 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)

Distinguished Co-Chairs:

Joanna Allen Senior Legal Counsel Elevance Health

What’s NEW for 2024:

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

Tim McMichael Deputy General Counsel

– Director of Litigation Premera Blue Cross

Adam Petitt Partner Robinson & Cole LLP

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

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

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.

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

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

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

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

Melissa Wong Partner

Holland & Knight LLP

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

PRE-CONFERENCE WORKSHOP

WEDNESDAY, MAY 1

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.

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

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

» 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

• Assessing the impact of the fiduciary exception on privilege

• Minimizing legal exposure for an ERISA suit

• Analyzing the intersection of ERISA with Medicare and Medicaid

• Exploring recent ERISA case law impacting the industry

• Examining the latest PBM fee litigation

Media Partner

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/

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

DAY ONE

7:45 Registration Opens and Continental Breakfast Served

8:45

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.

• 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

• Reviewing federal and state enforcement of surprise billing laws

» How CMS is approaching QPA audits

• Analyzing IDR outcomes for payors since the implementation of the process

» 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

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

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

» Lessons from retirement fee litigation

» Dissecting typical excessive fee litigation claims and common elements

• 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

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

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

4:30

Navigating A New Risk Adjustment Landscape: Key

Regulatory and Legal Considerations for Plans in 2024

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

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

7:45 Registration Opens and Continental Breakfast Served

8:50

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

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.

• 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

10:30 Morning Coffee and Networking Break

10:45

GC Perspectives on Improving Payor-Provider Relationships

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

12:30

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

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

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

• 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

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

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

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.

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,

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.