MAIN CONFERENCE DAY TWO

THURSDAY, MARCH 30

8:00 Registration Opens

8:15

Co-Chairs’ Opening Remarks

8:30

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

microphone-alt Carolyn Kapustij, Senior Advisor for Managed Care, HHS Office of Inspector General

The OIG is heavily focused on fighting fraud, waste, and abuse within managed care. To that end, recent oversight efforts have focused on Medicare Advantage risk adjusted payments, health risk assessments, chart reviews and the accuracy of provider data.

In this session hear directly from the HHS-OIG on 2023 initiatives, emerging areas of risk for MCOs, and key takeaways from recent compliance audits.

9:15

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

microphone-alt Jay Dewald, Partner, Norton Rose Fulbright

• Identifying the types of FCA cases emerging in Medicare and Medicaid managed care

» Adding codes, upcoding, false diagnoses, kickbacks, and compliance lapses

• Tracking FCA recoveries for 2022

» Examine recent DOJ criminal and civil actions taken against MCOs

» Practical insights on what they are looking for in investigations

• Exploring the latest from the Qui Tam bar

» Lesson learned from claims filed against MCO’s by Plaintiffs’ attorneys

10:00

How Support SDOH Initiatives and Mitigate FWA Risks Along the Way

Payers are increasingly looking for opportunities to develop policies and practices that will address the socioeconomic factors impacting member health. Many states are now including SDOH based requirements in Medicaid managed care contracts. Initiatives can include transportation to healthier food, or housing support.

The complexity of investment in these programs, that can include-non health initiatives, is an emerging area of risk for fraud, waste, and abuse. This session will examine how MCOs can be a SDOH partner, while managing those risks.

10:30 Morning Coffee and Networking Break

10:45

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

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

Emily Wey, Arbitrator and Mediator, Wey West Dispute Resolution

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

Lawyers and their clients come into arbitration or mediation wanting a result. They want to win, but they also want expeditious and less expensive dispute resolution. Combining a mixture of mediation and arbitration in the same case with the same neutral is a useful technique to understand. Just as drivers on a multi-lane highway shift from lane to lane as circumstances require while reaching their destination, disputants can move from settlement modes to arbitration and back again as circumstances warrant.

This session will explore when, and how to effectively engage these and other dispute resolution tools in the managed care environment. Panelists will provide insights on:

• When and how to leverage to mediation and arbitration tools in managed care disputes

• Tips on how to structure an efficient process

• Examples of managed care disputes resolved through mixed modes

• A behind-the-scenes look at what persuades arbitrators and how mediators work

11:30

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

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

Jason Joffe, Partner, Squire Patton Boggs LLP

Matthew R. Varzally, Senior Legal Counsel, Litigation

Trial is where the in-house outside counsel relationship is put to the test. In this session learn best practices for working together to secure a favorable outcome, and the pitfalls to avoid along the way.

12:15 Networking Luncheon

The Future of Mental Health Coverage: Access and Litigation

microphone-alt MODERATOR:

Kara Wheatley, Principal, Groom Law Group, Chartered

There is bipartisan support in congress for mental health reform. Examine how these ambitious policies are shaping up and the implications for the legal landscape.

Part one of this panel discussion will explore the future of mental health policy, including continuing enforcement challenges related to mental health parity and potential policy actions that could help improve access to mental health and SUD care.

Part two will take a closer look at burgeoning legal challenges, and strategies for defending a MHPAEA claim.

Key points of discussion include:

• Determining what laws need to be made to facilitate better access, evidence-based treatment

• Identifying what barriers need to be overcome to enforce and achieve mental health parity

• Exploring how can we fund and enforce these policies

• Predicting the potential direction of future of mental health policy look like

• Examining how the Mental Health Matters Act strengthens MHPAEA enforcement powers

• Survey of important cases to monitor, and key takeaways from trends in behavioral health cases

• How MCOs should prepare the lawsuit before it’s filed—key strategies for defending MHPAEA claims

2:30 Afternoon Coffee and Networking Break

3:00

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

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

Mike Cowie, Partner, Dechert LLP

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

PMBs have come under fire. “The FTC has launched a review of PBM services, including the role of vertical integration and the impact of PBMs on drug pricing. This panel will discuss the role of the FTC and other government actors and how to assess claims made by opposition groups.

3:45

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

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

Private equity investment amidst health care provider consolidation continues to pose challenges and opportunities for the managed care industry. Particularly following COVID-19, successful transactions often hinge on payor-provider alignment, network adequacy, and reimbursement. In this session, we will explore:

• Private equity provider-side investment structures and regulatory restrictions;

• Physician-provider alignment opportunities and value-based care

• Fraud and abuse considerations; and changes of control and participating provider agreement negotiations

4:30 Conference Concludes