The Health Law Section of the Colorado Bar Association, together with the American Health Lawyers Association, hosted the 2nd Annual Colorado Health Law Symposium, a regional event co-sponsored by the nation's largest educational organization devoted to legal issues in the health industry. Mitchell Raup, Polsinelli Antitrust Shareholder presented How to Form and Operate a Network of Competing Providers at the symposium.
A Road Map to Major Changes Coming to Multi-Employer Pension Plans: What Part...Polsinelli PC
To address the severe underfunding of multi-employer pension plans and the teetering finances of the Pension Benefit Guaranty Corporation ("PBGC"), the Multi-Employer Pension Reform Act of 2014 ("MPRA") was enacted last December in the most significant legislation affecting these plans since 1980. Among other changes, the MPRA gives troubled funds the ability to reduce the pension benefits of participants, including benefits for some retirees already in pay-status. It also gives additional flexibility to the PBGC to help underfunded plans by providing its financial assistance and facilitating fund mergers and partitions. There are also special rules under MPRA that may impact an employer's withdrawal liability.
This webinar, presented by Employee Benefits and Executive Compensation chair Andrew Douglass and Labor and Employment vice-chair Brad Kafka, discussed how the MPRA changes affect multi-employer pension plans, and specific actions that employers should consider in light of MPRA changes taking effect this year.
In today’s retirement plan industry, the unaddressed segment of the market is the one–third of private sector workers without
access to retirement benefits and Multiple Employer Plans (MEPs) are the disrupting force that can meet their needs.
Forward-‐thinking defined contribution retirement plan sponsors are recognizing the benefits of communicating to employees in a language
they can understand: monthly income. Investment solutions focused on income fundamentally improve the participant experience and ultimately deliver better outcomes.
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
NASPP Webcast Bankruptcy 101 for Compensation ProfessionalsEdward Hauder
This presentation provides an overview of what happens to typical compensation elements in a bankruptcy and walks through some of the basics of bankruptcy from a compensation professional's poitn of view.
Dodd-Frank Wall Street Reform and Consumer Protection Act, Executive Compensa...Edward Hauder
This presentation looks at the executive compensation provisions (Sections 951-957) and corporate governance provisions (Sections 971-972) of the Dodd-Frank Wall Street Reform and Consumer Protection Act.
A Road Map to Major Changes Coming to Multi-Employer Pension Plans: What Part...Polsinelli PC
To address the severe underfunding of multi-employer pension plans and the teetering finances of the Pension Benefit Guaranty Corporation ("PBGC"), the Multi-Employer Pension Reform Act of 2014 ("MPRA") was enacted last December in the most significant legislation affecting these plans since 1980. Among other changes, the MPRA gives troubled funds the ability to reduce the pension benefits of participants, including benefits for some retirees already in pay-status. It also gives additional flexibility to the PBGC to help underfunded plans by providing its financial assistance and facilitating fund mergers and partitions. There are also special rules under MPRA that may impact an employer's withdrawal liability.
This webinar, presented by Employee Benefits and Executive Compensation chair Andrew Douglass and Labor and Employment vice-chair Brad Kafka, discussed how the MPRA changes affect multi-employer pension plans, and specific actions that employers should consider in light of MPRA changes taking effect this year.
In today’s retirement plan industry, the unaddressed segment of the market is the one–third of private sector workers without
access to retirement benefits and Multiple Employer Plans (MEPs) are the disrupting force that can meet their needs.
Forward-‐thinking defined contribution retirement plan sponsors are recognizing the benefits of communicating to employees in a language
they can understand: monthly income. Investment solutions focused on income fundamentally improve the participant experience and ultimately deliver better outcomes.
Value-Based Payments and Managed Care Contracting - Crash Course Webinar SeriesEpstein Becker Green
Epstein Becker Green Webinar with Attorney Basil Kim - Value-Based Payments Crash Course Webinar Series - May 31, 2016.
As value-based payment relationships continue to grow in prevalence and complexity, a question remains: How do I effectively capture this arrangement on paper?
Topics include:
* Some of the key strategic questions to deliberate with regard to contracting in a value-based payment relationship
* Considerations for contracting under a value-based payment framework.
http://www.ebglaw.com/events/value-based-payments-and-managed-care-contracting-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
NASPP Webcast Bankruptcy 101 for Compensation ProfessionalsEdward Hauder
This presentation provides an overview of what happens to typical compensation elements in a bankruptcy and walks through some of the basics of bankruptcy from a compensation professional's poitn of view.
Dodd-Frank Wall Street Reform and Consumer Protection Act, Executive Compensa...Edward Hauder
This presentation looks at the executive compensation provisions (Sections 951-957) and corporate governance provisions (Sections 971-972) of the Dodd-Frank Wall Street Reform and Consumer Protection Act.
This presentation was used by Ed Hauder at the National Association of Stock Plan Professionals' Chicago Chapter meeting on December 8, 2009. In it Ed walks through the newly announced policy updates from RiskMetrics Group for 2010 as well as their Compensation FAQs, and then covers tips to get shareholders to approve equity plan proposals.
Numerous financial instruments and products are used in financial planning. Life insurance is an example of both because it assists individuals accomplish financial goals via a financial mechanism that is legally structured differently from other financial planning products such as 401(k)s and individual retirement accounts.
Paycheck Protection rogram v Pandemic Risk Insurance ActJasonSchupp1
Now that the Paycheck Protection Program (PPP) has taken form and policymakers begin exploring whether the Terrorism Risk Insurance Act (TRIA) could serve as a model going forward, it is useful to compare the PPP with a hypothetical Pandemic Risk Protection Act (PRIA).
The financing of a future pandemic risk program is the easy part to think through. The only ones with enough money to fund the economy during another COVID-19 scale lockdown are those who can print it. Any private funding within a pandemic risk program would be on the margins at most.
The more interesting questions for such a program are:
What benefits should be available to impacted businesses?
Which businesses should be entitled to claim those benefits?
Who has the infrastructural capabilities to deliver the necessary scale of benefits?
Neither the PPP model nor the PRIA model has good answers to all three questions. However, by comparing these approaches we can begin to see the outlines of what a viable program would look like. The attached is an effort to advance that conversation.
סלינגר למנכ"לי חברות הביטוח: חזקו את ההון הראשוני
בערב העיון השנתי לענף הביטוח שערך מכון קסירר אמרה המפקחת על הביטוח דורית סלינגר כי רמת ההון הראשוני של חברות הביטוח נמוכה מאוד. "אנו מצפים מהחברות להגדיל את ההון הראשוני שלהן, וכדאי שזה ייעשה באופן עצמאי ושהרגולטור לא ייאלץ להתערב" – אמרה סלינגר לראשי החברות
Joel Gilbertson, vice president of government and public affairs for Providence Health & Systems, provided a "Health Reform 101" presentation at the Alaska Providers Forum Sept. 2, 2010
Business Continuity Protection ProgramJasonSchupp1
On May 21 the National Association of Mutual Insurance Companies (NAMIC), the American Property Casualty Insurance Association (APCIA), and the Independent Insurance Agents & Brokers of America, Inc. (Big “I") released their proposal to address future pandemics: The Business Continuity Protection Program (BCPP).
ACA Healthcare legislation and attempts at increasing regulation of self-funding and stop loss coverage are driving more employers toward stop loss captives.
Overpayments, audits and reimbursement conundrums 7.7.15Polsinelli PC
This webinar will help health care entities strategize, manage and respond to both internal and external audits through which potential overpayments are found. Presenters will provide examples on how to navigate the resolution of potential overpayments and audits in unique reimbursement contexts. Polsinelli PC
60 day over payment reporting final rule 2.23.16Polsinelli PC
In this inaugural Reimbursement Institute webinar, Polsinelli attorneys will discuss the final Reporting and Returning Overpayments rule (a/k/a the 60-day rule) published on February 12, 2016. The webinar will cover the three main themes of the Rule: Identification of over-payments, the look back period and the mechanics of reporting and returning over-payment, as well as the operational tasks required of providers and suppliers to comply with the rule.
On our agenda:
The basics of the Rule
When are claims-based and cost-report-based over-payments “identified”
How long do providers/suppliers have to conduct their “Reasonable diligence” in determining whether an over-payment exists
How far back do provider/suppliers need to look for over-payments
What is the process for reporting and returning identifies over-payments?
What steps should providers/suppliers take in order to comply with the Rule by March 14, 2016?
This presentation was used by Ed Hauder at the National Association of Stock Plan Professionals' Chicago Chapter meeting on December 8, 2009. In it Ed walks through the newly announced policy updates from RiskMetrics Group for 2010 as well as their Compensation FAQs, and then covers tips to get shareholders to approve equity plan proposals.
Numerous financial instruments and products are used in financial planning. Life insurance is an example of both because it assists individuals accomplish financial goals via a financial mechanism that is legally structured differently from other financial planning products such as 401(k)s and individual retirement accounts.
Paycheck Protection rogram v Pandemic Risk Insurance ActJasonSchupp1
Now that the Paycheck Protection Program (PPP) has taken form and policymakers begin exploring whether the Terrorism Risk Insurance Act (TRIA) could serve as a model going forward, it is useful to compare the PPP with a hypothetical Pandemic Risk Protection Act (PRIA).
The financing of a future pandemic risk program is the easy part to think through. The only ones with enough money to fund the economy during another COVID-19 scale lockdown are those who can print it. Any private funding within a pandemic risk program would be on the margins at most.
The more interesting questions for such a program are:
What benefits should be available to impacted businesses?
Which businesses should be entitled to claim those benefits?
Who has the infrastructural capabilities to deliver the necessary scale of benefits?
Neither the PPP model nor the PRIA model has good answers to all three questions. However, by comparing these approaches we can begin to see the outlines of what a viable program would look like. The attached is an effort to advance that conversation.
סלינגר למנכ"לי חברות הביטוח: חזקו את ההון הראשוני
בערב העיון השנתי לענף הביטוח שערך מכון קסירר אמרה המפקחת על הביטוח דורית סלינגר כי רמת ההון הראשוני של חברות הביטוח נמוכה מאוד. "אנו מצפים מהחברות להגדיל את ההון הראשוני שלהן, וכדאי שזה ייעשה באופן עצמאי ושהרגולטור לא ייאלץ להתערב" – אמרה סלינגר לראשי החברות
Joel Gilbertson, vice president of government and public affairs for Providence Health & Systems, provided a "Health Reform 101" presentation at the Alaska Providers Forum Sept. 2, 2010
Business Continuity Protection ProgramJasonSchupp1
On May 21 the National Association of Mutual Insurance Companies (NAMIC), the American Property Casualty Insurance Association (APCIA), and the Independent Insurance Agents & Brokers of America, Inc. (Big “I") released their proposal to address future pandemics: The Business Continuity Protection Program (BCPP).
ACA Healthcare legislation and attempts at increasing regulation of self-funding and stop loss coverage are driving more employers toward stop loss captives.
Overpayments, audits and reimbursement conundrums 7.7.15Polsinelli PC
This webinar will help health care entities strategize, manage and respond to both internal and external audits through which potential overpayments are found. Presenters will provide examples on how to navigate the resolution of potential overpayments and audits in unique reimbursement contexts. Polsinelli PC
60 day over payment reporting final rule 2.23.16Polsinelli PC
In this inaugural Reimbursement Institute webinar, Polsinelli attorneys will discuss the final Reporting and Returning Overpayments rule (a/k/a the 60-day rule) published on February 12, 2016. The webinar will cover the three main themes of the Rule: Identification of over-payments, the look back period and the mechanics of reporting and returning over-payment, as well as the operational tasks required of providers and suppliers to comply with the rule.
On our agenda:
The basics of the Rule
When are claims-based and cost-report-based over-payments “identified”
How long do providers/suppliers have to conduct their “Reasonable diligence” in determining whether an over-payment exists
How far back do provider/suppliers need to look for over-payments
What is the process for reporting and returning identifies over-payments?
What steps should providers/suppliers take in order to comply with the Rule by March 14, 2016?
Labor and Employment Roundtable Privacy Rights and Other Onboarding IssuesPolsinelli PC
Hire The Best Without Making A Mess! Application forms, background checks, the interview process, immigration status, and even actions during the onboarding process are fraught with legal landmines these days. There are more privacy protections, employment laws, immigration requirements and lawsuits (including class action lawsuits) filed today than ever before based on the hiring and onboarding process. It is critical that all employers know which policies, procedures, and questions are required and safe when hiring and onboarding employees, and which are not.
This roundtable discussion is intended to be an interactive discussion focused on various "do" and "don't" tips related to privacy rights during the hiring process, criminal convictions, immigration, medical examinations, drug tests and background checks.
OUR PANEL:
• Jeffrey S. Bell, Shareholder
• Denise K. Drake, Shareholder
• Erin D. Schilling, Shareholder
• Emma R. Schuering, Associate
Provider collaboration and coordination are increasingly important pathways to business success in the post-Affordable Care Act environment, but the FTC and other antitrust enforcement agencies remain focused on the antitrust compliance risks of collaboration and consolidation. Our webinar reviews pertinent antitrust law and enforcement agency policies, and suggests practical guidance regarding clinical integration and related issues for health care providers to consider as they implement an antitrust compliance strategy in today's challenging health care marketplace.
Hot topics in employment law SHRM presentation April 8, 2015Polsinelli PC
Did you know that pregnancy discrimination is one of the EEOC's top 5 areas of focus? Learn more about this topic along with information around disability, transgender/gender identity and sexual orientation, wellness programs and obesity as it relates to the law.
Erin Schilling provides advice, counsel, and peace of mind so that employers can focus on what they do best – operating their business. Erin provides counsel to clients on a variety of employment issues including retaliation, leave issues and discrimination including age, race, disability, religion, national origin, and sex discrimination.
Key issues in physician alignment and compensation 6 7-15Polsinelli PC
Developing and implementing effective physician alignment and compensation strategies is essential to the stability and success of any health care entity. Alignment and compensation strategies that evolve along with industry trends and follow proven "best practices" will yield dividends from both a legal and fiscal standpoint, and ensure that health care organizations and providers enjoy stable and productive relationships that reduce the probability of future challenge.
Are You Following the Script? Consequences for Medical Professionals Who Fail to Check Pharmacy Registries
As the problem of prescription drug addiction has grown, states have responded with the creation of prescription registries controlled by pharmacy boards. Anyone prescribing medications (specifically doctors, physician assistants and nurse practitioners) is required to check these registries before prescribing certain drugs, but this step is often missed. If discovered, failure to closely monitor your patient could result in discipline up to the loss of your license to practice medicine.
Cms 5 star webinar health care may 6 2015Polsinelli PC
Changes to CMS' Five-Star Ratings System Turn Up the Heat on Nursing Homes and Increase Risks for Psychotropic Use. On Feb. 20, 2015, the Centers for Medicare & Medicaid (CMS) unveiled Version 3.0 of its Nursing Home Compare, which updates the current 5-Star Quality Rating System to reflect higher performance standards. Because of these changes, not only will it will be increasingly difficult for nursing homes to earn the much-desired four-star and five-star ratings, but also the ratings for many nursing homes may immediately fall by one or more stars.
Additional topics of discussion:
What will change
What providers should do
What providers should know
Presenters:
Matthew J Murer, Shareholder and Healthcare Practice Group Chair, Polsinelli
Kathryn M. Stalmack, Shareholder, Polsinelli
Polsinelli's Gene Commander and Ryan E. Warren presented at the AGC Colorado Association Executive Leadership Academy. The Academy prepares next new leaders for the C-Suite. Polsinelli co-hosted the event with AGC and FMI.
In the wake of the Multiemployer Pension Reform Act of 2014 (the "MPRA"), companies that participate in multiemployer pension funds should take note of recent developments impacting their withdrawal liability risks and the collective bargaining strategies with their unions. Employers should also review their pension fund's latest financial information, which most plans have recently updated. This webinar will provide an overview of how the post-MPRA landscape for troubled multiemployer pension plans has continued to evolve, as well as a handy "road map" for employers to use to better manage the many risks that come with participation in these funds.
Government Investigations and Enforcement ActionsPolsinelli PC
The fifth webinar presentation in the M&A Litigation Series examines compliance pitfalls associated with M&A transactions. We will discuss how to evaluate antitrust risks of a transaction. We also will address compliance concerns – such as antitrust, the Foreign Corrupt Practices Act, the False Claims Act, and export control issues – that could significantly impact the scope, duration, and magnitude of necessary due diligence. Finally, we will address post-merger considerations that could decrease the severity of a compliance concern if one were to arise after a merger or acquisition has been completed.
On our agenda:
-Pre-transaction – evaluating the transaction itself from an antitrust perspective
-Pre-closing – managing client conduct and the risk of “gun jumping”
-Due Diligence – what to look for
-Post-merger considerations for fostering and perpetuating a “Culture of Compliance”
-Managing compliance concerns that are discovered post-closing
The Ruby Files: A Whisper, a Wink, and a 40 Year-Old Aptitude FlunkyPolsinelli PC
In the third of our webinars on The Ruby Files: Managing the Challenging Employee, we continue to follow Ruby as her changing circumstances present her employers with a variety of legal complications. View previous installments here.
Ruby now works at a bank, which happens to be subject to the Office of Federal Contract Compliance Programs (OFCCP). In her application materials she didn’t mention she was previously fired, and when the bank learns of the misrepresentation it wants to take action. However, the bank has a history of unevenly applying such a policy, and as a result it may be risky to fire Ruby.
While the company mulls next steps, Ruby flirts with a supervisor in another department and then claims sexual harassment; after a company investigation Ruby is kept on staff but placed in a separate department from the supervisor. Just in time for her 40th birthday, Ruby fails an aptitude test and promptly claims the test has a disparate impact on individuals over 40. She quits the job at the bank, updates her resume, and prepares to take another company by storm in our next installment.
Leveraging Corporate Integrity Agreements for Healthcare CompliancePolsinelli PC
An effective compliance program is essential for healthcare providers and companies. These programs should be reviewed and updated according to the latest guidance. OIG's Corporate Integrity Agreements shed light on where the enforcement "hot spots" are, as well as identify potential areas of risk that your compliance program should address. Monitoring CIA trends provides much needed guidance to help shape an effective compliance program.
Additional topics of discussion:
Recent trends and developments in CIAs and what they mean for compliance programs
Best practices to prevent a CIA
Best practices for leveraging CIA lessons in your compliance program
Presenters:
Brian D. Bewley, Shareholder, Polsinelli
Jennifer L. Evans, Shareholder, Polsinelli
Navigating the real estate road avoiding pitfalls and potholes march 2015 ssPolsinelli PC
Commercial property developers, owners and brokers know that the road to a successful real estate deal is not always a smooth highway, and some of the twists and turns are more easily handled than others. Obstacles that have frequently led to litigation can provide valuable lessons on how to avoid future bumps. Polsinelli's Real Estate Litigation attorneys address common issues in the real estate industry that have led to litigation, and advise on steps that can be taken in the negotiation, drafting and early dispute processes to ultimately avoid the courtroom.
Does your wellness plan need a compliance check?Polsinelli PC
Wellness programs are designed to promote employee health and fitness in hopes of also lowering a company's costs in providing medical benefits. W. Andrew Douglass, Shareholder and chair of Polsinelli's Employee Benefits and Executive Compensation practice, was joined by Associate Anne Prenner Schmidt to discuss:
*General overview of wellness programs, including health screening features, premium incentives, and other common plan designs
*Compliance issues for wellness programs under the *Americans with Disabilities Act (ADA), Affordable Care Act (ACA), and other federal laws
*Discussion of recent lawsuits brought by the EEOC against employers, and expectations for the EEOC's future regulations for wellness programs
*Action items for in-house counsel, as well as human resources and financial professionals in navigating the uncertainties and risks in offering wellness programs to their employees.
Distressed asset sales both in bankruptcy and out-of-court alter Feb 2015 Polsinelli PC
Given the economic downturn of recent years, professionals' fees and costs have been a driving factor in conducting the acquisition of distressed assets. A majority of these transactions take place pursuant to section 363 of the Bankruptcy Code. However, out-of-court alternatives such as Receiverships, Assignments for the Benefit of Creditors, and Article 9 of the Uniform Commercial Code have gained momentum to bankruptcy as expeditious and cost-efficient alternatives.
This webinar focuses on the sale of distressed assets under each of these alternatives, including bankruptcy and a special emphasis on the sale or acquisition of distressed health care assets.
Defend Trade Secrets Act of 2016: A Polsinelli Update SeriesPolsinelli PC
Just last Wednesday, President Obama signed into law a major revision to U.S. trade secrets law. Entitled the Defend Trade Secrets Act of 2016 (“DTSA”), the legislation creates, for the first time, a Federal private, civil cause of action to protect trade secrets. As an additional body of protection over and beyond current state law, the legislation provides for nationwide substantive and procedural consistency and enhances the basic remedies of injunctive relief and damages. Most significantly, for the first time, it will provide for ex parte civil seizure of stolen trade secrets.
The following provisions of the new law will be discussed, along with implications for labor and employment practitioners:
-Details of the new law’s major provisions and the differences from and advantages over current state law;
-Requirements for and limitations on obtaining ex parte seizure;
-Enhanced judicial protections from disclosure in litigation;
-New protections for whistleblowers who disclose trade secrets to governmental authorities or courts;
-New requirements for employment agreements and policy documents containing confidentiality provisions
When Enrollment Goes Wrong: Successfully Navigating and Avoiding the Pitfalls...Polsinelli PC
This presentation will provide a brief overview of the Medicare enrollment process for different types of providers and suppliers. We will address the nuts and bolts of obtaining access to PECOS – the electronic Medicare enrollment database, best practices in compliance monitoring, and the consequences of not correctly addressing enrollment issues on the front-end. Our discussion will use specific examples to demonstrate when enrollment goes wrong.
This webinar will discuss:
-Consequences of Improper Enrollment
-Understanding the Enrollment Process and resources related to
-Develop internal expertise and Standard Practices
-Medicare Overview, 855 submission and when enrollment goes wrong
An employee's relationship with the company can terminate for many reasons – resignation, reduction-in-force, performance and other work-related reasons. Planning for the departure of an employee, for any of these reasons, can minimize disruption, protect confidential information, avoid litigation and assist with succession planning. Join Polsinelli's Labor and Employment attorneys for the conclusion of our year long Life Cycle of an Employee Webinar series as we discuss issues related to employee terminations, including:
Managing performance and attendance related terminations
Can you terminate whistle-blowers
Exit Interviews
Protecting intellectual property and confidential information
Reductions-in-force and other separation agreements
Post-decision considerations and communications
This presentation by Russell Damtoft (US FTC) was made during a roundtable discussion on Advocacy and Mainstreaming competition policy held at the 12th meeting of the OECD-IDB Latin American Competition Forum on 16-17 September 2014, Uruguay. Find out more at www.oecd.org/competition/latinamerica/
Mergers Acquisitions and Other Restructuring Activities 9th Edition DePamphil...lujepyce
Full download : http://alibabadownload.com/product/mergers-acquisitions-and-other-restructuring-activities-9th-edition-depamphilis-solutions-manual/
Mergers Acquisitions and Other Restructuring Activities 9th Edition DePamphilis Solutions Manual
A presentation a friend and I worked on while brainstorming ideas for a technology startup. Our objective was to explore opportunities in industries we're familiar with and industries we believe are ripe for disruption. The presentation lays out key industry metrics and profiles successful companies (somewhat startup-focused) within each industry.
This presentation by Miguel de la Mano, Executive Vice President at Compass Lexicon, was made during the Workshop on market studies selection and prioritisation of sectors and industries held on 9 March 2017 at the OECD Headquarters. More papers and presentations on the topic can be found out at http://www.oecd.org/daf/competition/market-studies-workshop-on-selection-prioritisation-of-sectors-industries.htm
Stand on the Sidelines, or Boost Competitiveness? How to Make Bold Moves on t...Accenture Insurance
Sweeping changes across consumer behavior, technology innovations and big data are reshaping traditional insurance business models and what it takes to compete. The most successful insurers are the ones that will proactively adapt their game plan to the evolving environment and rules of competition. This piece explores three strategies to better position insurers for the future.
Compliance Design in a World of New Models PYA, P.C.
This presentation discusses mitigating compliance risks presented by new payment models, creating a compliance culture through human resources, leveraging new regulations to increase access to care and reduce costs, and how to educate start-ups and nontraditional facilities about integrity principles within compliance programs.
Supplying innovation: Unlocking innovative behaviours in the supply chainKeith Wishart
IBM in conjunction with the researchers and other industrial partners at the Cambridge Services Alliance have been looking into ecosystem collaboration and how to put in place incentives to drive innovation and performance. Thinking about alliances with common objectives rather than traditional client-supplier relationships can unlock new value. Here is a short management summary of some of the work the team have done to date and some simple pointers to the keys to this value:
This presentation by Anna Pisarkiewicz (Research Fellow, EUI Centre for a Digital Society) was made during a discussion on Remedies and commitments in abuse cases at the 21st meeting of the OECD Global Forum on Competition on 2 December 2022. More papers and presentations on the topic can be found out at https://oe.cd/rcac.
This presentation was uploaded with the author’s consent.
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Tax Cuts & Job Act Implications for Small Business Investments Companies Polsinelli PC
On December 22, 2017, the President signed into law a federal tax reform bill commonly known as the Tax Cuts & Jobs Act (the “Tax Act”). The Tax Act resulted in significant changes to the U.S. tax system on a number of fronts. This webinar will provide an overview the provisions of the Tax Act relevant to SBIC’s. We will also address the impact of the Tax Act upon the choice of entity decisions and a number of ancillary matters.
Preventing Compliance Quagmires in Senior Living Communities: Part 1 - Can So...Polsinelli PC
During this webinar we will explore the regulatory, operational and employment related issues that arise when long term care staff use social media at work in the long term care setting.
Health Care "Prime" - The Future of the Ownership, Organization, Payment, and...Polsinelli PC
The potential for disruption and disaggregation of traditional and incumbent players is occurring across the health care ecosystem and care continuum, and may accelerate through the intended and unintended consequences of this innovative new venture. Is this partnership a seminal event in defining the future of health care? Author William Gibson said, “The future is already here – it’s just not very evenly distributed.” This statement applies as the future of health care fast approaches, but with variability across stakeholders, their businesses, and the communities in which they provide care as part of one of America’s largest industries.
A diverse panelist group will bring a broad range of current perspectives and insights related to this partnership. From the base of the panelists’ unique perspectives, they will discuss their views on the likely near-, mid- and long-term implications of this announced venture on the ownership, organization, payment, and delivery of health care products, supplies and services in America.
The Trump Labor Board Goes Back to the FuturePolsinelli PC
The last weeks of 2017 brought significant changes to the National Labor Relations Board and federal labor law. Polsinelli’s Traditional Labor Practice Group will cover all of these changes, including the short-lived Republican majority, the new Board members and General Counsel, a recap of the major decisions reversing several of President Obama’s pro-employee initiatives over the last eight years, and discuss what is in store for employers in 2018.
Lessons learned from litigating real estate development projectsPolsinelli PC
Real estate development projects are filled with uncertainty. Zoning and permitting denials, disputes with neighboring property owners and citizen groups, and ambiguity in development contracts can cause significant setbacks to even the most well planned developments. This webinar will explore the many pitfalls of the development process and how to navigate them. Four Polsinelli attorneys offer their guidance and insights gained from litigating these very types of issues.
Datascram is being called a massive “Datascam.” Engineers cut corners and, as it turns out, data is not deleted forever. Instead, once deleted, it resides on a Nigerian server where it is sold to the highest bidder. As the company prepares to shut its doors, new questions emerge about Damian Diamond’s role in the fiasco and whether he could be held personally responsible for the company’s potentially criminal activities.
How to Obtain Permanent Residency in the NetherlandsBridgeWest.eu
You can rely on our assistance if you are ready to apply for permanent residency. Find out more at: https://immigration-netherlands.com/obtain-a-permanent-residence-permit-in-the-netherlands/.
NATURE, ORIGIN AND DEVELOPMENT OF INTERNATIONAL LAW.pptxanvithaav
These slides helps the student of international law to understand what is the nature of international law? and how international law was originated and developed?.
The slides was well structured along with the highlighted points for better understanding .
ALL EYES ON RAFAH BUT WHY Explain more.pdf46adnanshahzad
All eyes on Rafah: But why?. The Rafah border crossing, a crucial point between Egypt and the Gaza Strip, often finds itself at the center of global attention. As we explore the significance of Rafah, we’ll uncover why all eyes are on Rafah and the complexities surrounding this pivotal region.
INTRODUCTION
What makes Rafah so significant that it captures global attention? The phrase ‘All eyes are on Rafah’ resonates not just with those in the region but with people worldwide who recognize its strategic, humanitarian, and political importance. In this guide, we will delve into the factors that make Rafah a focal point for international interest, examining its historical context, humanitarian challenges, and political dimensions.
In 2020, the Ministry of Home Affairs established a committee led by Prof. (Dr.) Ranbir Singh, former Vice Chancellor of National Law University (NLU), Delhi. This committee was tasked with reviewing the three codes of criminal law. The primary objective of the committee was to propose comprehensive reforms to the country’s criminal laws in a manner that is both principled and effective.
The committee’s focus was on ensuring the safety and security of individuals, communities, and the nation as a whole. Throughout its deliberations, the committee aimed to uphold constitutional values such as justice, dignity, and the intrinsic value of each individual. Their goal was to recommend amendments to the criminal laws that align with these values and priorities.
Subsequently, in February, the committee successfully submitted its recommendations regarding amendments to the criminal law. These recommendations are intended to serve as a foundation for enhancing the current legal framework, promoting safety and security, and upholding the constitutional principles of justice, dignity, and the inherent worth of every individual.
WINDING UP of COMPANY, Modes of DissolutionKHURRAMWALI
Winding up, also known as liquidation, refers to the legal and financial process of dissolving a company. It involves ceasing operations, selling assets, settling debts, and ultimately removing the company from the official business registry.
Here's a breakdown of the key aspects of winding up:
Reasons for Winding Up:
Insolvency: This is the most common reason, where the company cannot pay its debts. Creditors may initiate a compulsory winding up to recover their dues.
Voluntary Closure: The owners may decide to close the company due to reasons like reaching business goals, facing losses, or merging with another company.
Deadlock: If shareholders or directors cannot agree on how to run the company, a court may order a winding up.
Types of Winding Up:
Voluntary Winding Up: This is initiated by the company's shareholders through a resolution passed by a majority vote. There are two main types:
Members' Voluntary Winding Up: The company is solvent (has enough assets to pay off its debts) and shareholders will receive any remaining assets after debts are settled.
Creditors' Voluntary Winding Up: The company is insolvent and creditors will be prioritized in receiving payment from the sale of assets.
Compulsory Winding Up: This is initiated by a court order, typically at the request of creditors, government agencies, or even by the company itself if it's insolvent.
Process of Winding Up:
Appointment of Liquidator: A qualified professional is appointed to oversee the winding-up process. They are responsible for selling assets, paying off debts, and distributing any remaining funds.
Cease Trading: The company stops its regular business operations.
Notification of Creditors: Creditors are informed about the winding up and invited to submit their claims.
Sale of Assets: The company's assets are sold to generate cash to pay off creditors.
Payment of Debts: Creditors are paid according to a set order of priority, with secured creditors receiving payment before unsecured creditors.
Distribution to Shareholders: If there are any remaining funds after all debts are settled, they are distributed to shareholders according to their ownership stake.
Dissolution: Once all claims are settled and distributions made, the company is officially dissolved and removed from the business register.
Impact of Winding Up:
Employees: Employees will likely lose their jobs during the winding-up process.
Creditors: Creditors may not recover their debts in full, especially if the company is insolvent.
Shareholders: Shareholders may not receive any payout if the company's debts exceed its assets.
Winding up is a complex legal and financial process that can have significant consequences for all parties involved. It's important to seek professional legal and financial advice when considering winding up a company.
How to Form and Operate a Network of Competing Providers
1. Polsinelli PC. In California, Polsinelli LLP
Antitrust Rules for Provider Collaboration:
How to Form and Operate a
Network of Competing Providers
Mitchell D. Raup
March 13, 2015
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Agenda:
Antitrust Rules for Provider Collaboration
Why collaborate?
Integration strategies
Ancillarity: what agreements are
reasonably related to the network’s
legitimate goals?
Rule of reason analysis
Practical advice for structuring antitrust-
compliant provider networks
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Why Collaborate?
Competing providers often cooperate to
offer services to payers:
Physicians form a group practice;
Larger groups of physicians form an IPA;
Hospitals and physicians form a PHO;
PHOs form a statewide network.
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Why Collaborate?
Collaborations offer value to payers:
One-stop shopping;
Better care coordination;
Cost reductions by eliminating duplication;
A network large enough to manage
population health and take risk.
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Antitrust Risks of Collaboration
Pricing may be per se illegal price-fixing.
Pricing may violate § 1 under the rule of
reason.
Agreements allocating patients may
violate § 1 as an illegal market allocation.
If market shares are high, the joint venture
may violate § 2 of the Sherman Act, which
prohibits monopolization.
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Basic Questions to Begin
the Antitrust Analysis
What is the purpose of the network?
How much integration does it need?
What decisions will providers make jointly?
Will the network be exclusive?
What market share will the network have?
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FTC Guidance on Provider Networks
Statements of Antitrust Enforcement
Policy in Health Care (August 1996)
Statement of Antitrust Enforcement Policy
Regarding Accountable Care
Organizations (October 2011)
Advisory opinions on specific networks
– Four approved
– One rejected
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Integration Strategies
Integration is a fundamental issue for
provider networks.
Networks without integration may not:
– jointly negotiate price,
– allocate services to eliminate duplication, or
– enter into any other agreements that would be
illegal for a group of competitors.
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Integration Strategies
Messenger model (no integration)
Clinical integration
Financial integration
Hybrid strategies (clinical and financial)
Single-entity strategies
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Messenger Model
Competing providers who are not
integrated can form a network, but they
can’t agree with each other on price.
Each provider must negotiate his own
contract with the payer.
The messenger can facilitate that
negotiation by conveying offers and
counteroffers.
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Messenger Model
The messenger may:
Analyze a payer’s offer and compare it to others.
Negotiate contract terms other than price.
Communicate offers and acceptances.
Compile providers’ minimum acceptable prices.
Be authorized to accept offers above that price.
Inform payers that X% of providers would accept
an offer.
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Messenger Model
A messenger may not:
Be one of the network providers.
Negotiate price.
Coordinate individual providers’ responses.
Encourage providers to refuse to deal.
Disclose any provider’s price or negotiating
position to a competing provider.
Recommend acceptance or rejection of an offer.
Refuse to communicate a bona fide offer.
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Messenger Model
Messenger model strategies are risky:
It’s easy to violate the rules
– If the messenger negotiates, or
– If the providers share information and plans.
Any violation of the rules may lead to per
se illegal price-fixing.
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Clinical Integration
“An active and ongoing program to evaluate
and modify practice patterns . . . and create
a high degree of interdependence and
cooperation . . . to control costs and ensure
quality.”
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Clinical Integration
Clinical integration generally requires:
A clear set of cost and quality goals;
Selectively choosing providers;
Significant investment of capital;
Electronic clinical records systems;
Comprehensive evidence-based clinical
guidelines;
Rigorous guideline implementation; and
In-network referrals to participating specialists.
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Clinical Integration
There is no formula or list of required
steps.
The key issue is whether the network’s
clinical integration has a real likelihood of
changing providers’ practice patterns and
thereby achieving the network’s cost and
quality goals.
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Clinical Integration
Clinical integration takes time.
Providers ask: “How much clinical
integration do I need before my network
can negotiate payer contracts without fear
of liability for per se illegal price-fixing?”
The FTC has offered two answers.
A private standard-setting body offers a
third.
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Clinical Integration
1. FTC Advisory Opinion to Norman PHO:
Non-exclusive network;
Clinical practice guidelines;
Electronic records allow network to
monitor and enforce clinical guidelines;
Providers commit to follow guidelines;
Substantial investments of capital;
Selective choice of providers.
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Clinical Integration
2. ACO Statement: If a network is
approved by CMS and participates in the
Medicare Shared Savings Program, the FTC
will presume that:
The network is clinically integrated;
Price negotiations are ancillary to
legitimate goals; and therefore
Negotiations with commercial payers are
not illegal per se.
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Clinical Integration
3. Third-party accreditation of clinical
integration:
Clinical Integration Accreditation and
Accountable Care Accreditation Standards
developed by URAC.
Standards track 1996 Health Care
Statements and FTC advisory opinions.
Independent audit.
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Financial Integration
All network providers “share substantial
financial risk in providing all the services
that are jointly priced through the network.”
Risk-sharing gives all providers a financial
incentive to help the network reduce cost
and improve quality.
“Substantial financial risk” means enough
to influence practice patterns.
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Financial Integration
Integration by contract between providers:
Providers co-own network, and share in its
profits and losses as owners;
Contractual joint venture, to share some or
all profits and losses on network business;
Contribute a substantial share of revenue
to a risk pool, to be paid back only if the
network meets its cost and quality goals.
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Financial Integration
Integration through the network’s contracts
with payors:
Capitation or case-rate contracts;
Withhold arrangements;
Bonus, shared savings and other pay-for-
performance contracts.
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Financial Integration
Financial integration can be achieved
quickly, by contract.
The key issue is whether financial
integration gives providers incentives to
reduce costs that outweigh the normal fee-
for-service incentive to increase costs.
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Hybrid strategies
Most successful networks use a combination
of clinical and financial integration:
Networks offer providers financial
incentives to follow clinical guidelines, or
to achieve cost or quality goals;
Pay-for-performance contracts with
payers, tied to clinical integration goals;
Clinical integration positions network to
accept risk.
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Single-Entity Strategies
Most networks make decisions by
agreement among providers, which are
reviewed under the rule of reason.
But a tightly integrated network may be
considered a single entity.
A single entity can’t conspire with itself; its
decisions are not agreements and
therefore can’t be challenged under § 1.
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Single-Entity Strategies
Limited case law:
Copperweld (U.S. 1984): parent and
subsidiary are a single entity.
Texaco v. Dagher (U.S. 2006) (dicta): a
corporate joint venture is a single entity.
Susquehanna (M.D. Pa. 2003): a
contractual joint venture is a single entity.
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Single-Entity Strategies
Medical Center at Elizabeth Place (S.D.
Ohio 2014): A hospital joint operating
agreement created a single entity.
Central management with all “operational,
strategic, and financial control”;
Sharing of all income, profits and losses;
“All of the money goes to one bottom line.”
Held: No § 1 liability, because “incapable
of conspiring.”
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Single-Entity Strategies
Maximum antitrust protection if your
network’s members are willing to
– pool all income,
– share all profits and losses, and
– delegate all business decisions to
network management.
No need to share ownership of assets.
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What Agreements Are Permitted?
A properly integrated network can make
agreements that are “reasonably
necessary” to achieve the network’s
legitimate goals.
When is joint price negotiation “reasonably
necessary” to achieve legitimate goals?
Again, the FTC offers two answers.
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What Agreements Are Permitted?
1. FTC advisory opinions: joint negotiation
of payor agreements is reasonably
necessary if the agreements:
Create financial integration (e.g., capitated
agreements).
Create clinical integration (e.g., financial
incentives for achieving clinical integration or for
achieving cost or quality goals).
Assure the full participation of all network
providers in each payor contract.
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What Agreements Are Permitted?
FTC advisory opinions: joint negotiation of
payor agreements is not reasonably
necessary:
Simply to achieve higher fees (even if
providers would not participate unless paid
higher fees).
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What Agreements Are Permitted?
2. ACO Statement:
If the network is approved by CMS and
participates in the Medicare Shared Savings
Program, the FTC will presume that the
network’s “joint negotiations with private
payers [are] reasonably necessary to an
ACO’s primary purpose of improving health
care delivery.”
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Rule of Reason
Unless the network is a single entity, its
actions and agreements are subject to the
rule of reason.
– Even if the network is properly integrated,
– Even if the agreement is reasonably
necessary to proper goals.
Networks that can and do reduce market-
wide competition are at risk.
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Rule of Reason
Market share and market power:
Will the network have a high market share
in any specialty, in any geographic
market?
Will the network be a “must-have” provider
for payers?
Will the network’s joint contracting lead to
higher prices?
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Rule of Reason
Market share and market power: How big is
too big?
ACO Statement: 30% or less is a safety
zone.
FTC’s last two successful prosecutions
(Promedica and St. Luke’s) alleged shares
of 80%.
Realistic danger zone: 50% or more.
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Rule of Reason
Exclusivity:
Market power concerns can be reduced by
making the network non-exclusive, meaning that
providers are free to contract directly with
payers.
In its Norman PHO opinion, the FTC approved a
network without considering its market share,
because the network would be non-exclusive.
Must be non-exclusive in fact, not just in name.
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Rule of Reason
Effects on cost and quality:
Price increases signal that the network
may be anticompetitive.
Cost reductions (if passed on to payors)
and quality improvements signal that the
network is procompetitive.
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Rule of Reason
Do courts “balance” quality improvements
against price increases?
FTC v. St. Luke’s (9th Cir. 2015) says no:
– “[T]he Clayton Act does not excuse mergers
that lessen competition or create monopolies
simply because the merged entity can
improve its operations.”
– “It is not enough to show that the merger
would allow St. Luke's to better serve its
patients.”
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Rule of Reason
Does the FTC “balance” quality
improvements against price increases?
The FTC says yes:
– The FTC will “carefully consider evidence that
the transaction will benefit consumers through
improved quality, new services and/or
decreased costs.”
– “Efficiencies may enhance a merged firm's
ability and incentive to compete.”
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Practical Advice
Integrate providers for the right reasons:
– to improve quality,
– reduce costs, and
– achieve better patient outcomes
not just to negotiate higher fees.
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Practical Advice
Be sure that your documents reflect your
proper purposes.
Be sure that your discussions focus on
them.
Bad documents can sink a good deal.
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Practical Advice
Be aware of your network’s market share
in each specialty, and how it changes over
time.
If your share is high enough that payers
“must have” your providers, the safest
course is to be truly non-exclusive.
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Practical Advice
Build a product that payers will want to buy.
Payers will pay for demonstrated
improvements in quality, efficiency and
outcomes.
Involve payers in the development of the
network, to be sure they will support it.
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Contact Information
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Polsinelli PC
www.polsinelli.com
Mitchell Raup
Antitrust Shareholder
Washington, D.C.
202.626.8352
mraup@polsinelli.com
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About Polsinelli
Polsinelli, a national law firm ranked among the Am Law 100 with over 740
attorneys located in 19 offices, deliberately seeks constant improvement in all
that we do. At its inception more than forty years ago, the firm established a
culture of openness and entrepreneurship that still pervades today. As the
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Lawyer*, the firm’s growth has been fueled by the recruitment of like-minded
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Polsinelli attorneys successfully build enduring client relationships by providing
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