October 19, 2022

The NYS Council wants our members to have a clear understanding of the rules of the road related to sharing information about rates and other provisions in their contracts with commercial insurers. To this end, we will host an important one-hour training on Friday, October 28, from 9:00-10:00 sharp. Please save the date!  We will send a Zoom link to everyone receiving this email on Wednesday, October 26 at 10:00 a.m.  

More about the Training:

Commercial Contracts and Antitrust: Why it is Never a Good Idea to Share Reimbursement Rates with Other Providers

Health plans generally regard reimbursement rates as confidential and proprietary information.  As a result, disclosure of negotiated rates to other agencies can result in breach of confidentiality obligations under an agency’s commercial contracts, potentially triggering financial penalties and terminations.  More problematic, discussion of negotiated rates with other agencies can be viewed as unlawful price-fixing activities under federal antitrust law.  This webinar will offer recommendations to comply with commercial contracts and federal antitrust laws and explain the limited circumstances in which agencies may share payment rates with third parties without running afoul of legal obligations. 

The speaker for this webinar, Adam Falcone, is a partner at Feldesman Tucker Leifer Fidell LLP.  Prior to joining the law firm, Adam served as Trial Attorney in the Antitrust Division of the U.S. Department of Justice, where he was assigned to the Health Care Task Force.  

Adam Falcone has served as our contracting consultant for over a decade, providing training and technical assistance to our members on a wide range of topics.  In addition, Adam provided legal counsel throughout our recent (successful) effort to compel NYS to enforce a Medicaid managed care contract provision that led to a recoupment of state overpayments made to MCOs.  Our advocacy efforts returned $222M to OASAS and OMH. 

Note:  This is the first in a series of NYS Council hosted trainings designed to address various aspects of contracting with insurers.  Stand by for further information about additional offerings.