DAY ONE
THURSDAY, MAY 2
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
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12:00
The level of expertise of both the speakers and attendees results in meaningful discussions and practical advice.”
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 Kara Petteway Wheatley, Principal, Groom Law Group, Chartered
Eli Burriss, Partner, Katten Muchin Rosenman LLP
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
2:45 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
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DAY TWO FRIDAY, MAY 3
7:45 Registration Opens and Continental Breakfast Served
8:50
Co-Chairs’ Opening Remarks
microphone-alt Joanna Allen, Senior Legal Counsel, Elevance Health
This has historically been the best conference in Managed Care.”
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
microphone-alt Joseph E. Laska, Partner, Manatt, Phelps & Phillips, LLP
Andrew Holmer, Partner, Crowell & Moring LLP
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
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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
» 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
Media Partner
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
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Supporting Sponsors
Crowell’s team of healthcare practitioners around the country draws on decades of experience to deliver quality counsel and industry leadership on the most significant issues in the field. We represent many of the nation's leading healthcare managed care organizations, providers, non-profits, vendors, digital health companies, and manufacturers. We also work closely with Crowell Health Solutions, our strategic consulting firm focused on helping clients advance their digital health, health equity, and value-based healthcare products and services.
What do you want to achieve? It’s more than what you do: it’s how you do it. Across sectors and borders, in board rooms and courtrooms, we measure our success by yours. And in our interactions, we commit to making your O’Melveny experience as satisfying as the outcomes we help you achieve. Our greatest accomplishment is ensuring that you never have to choose between premier lawyering and exceptional service. So, tell us. What do you want to achieve?
BRG provides both privileged consulting and expert testimony services to healthcare clients and their outside counsel throughout the compliance, litigation and investigation continuum. BRG experts have been retained on many of the largest and most complex commercial disputes and government investigations in the healthcare industry. We approach each matter with real-world industry expertise, advanced analytics, and actionable insights.
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.
Questions about CLE credits for your state? Visit our online CLE Help Center at www.AmericanConference.com/Accreditation/CLE/
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