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David Kopans

David E. Kopans

Partner
About

David Kopans represents health care and health insurance organizations with a focus on provider-payer relationships and value-based payments and other managed care matters. He regularly advises his clients on complex contractual and transactional arrangements and provides regulatory compliance advice on a broad range of managed care and insurance matters.

David's clients have included national and regional health insurers, internationally renowned health systems, foreign national health care systems, innovative and cutting-edge telehealth and digital health start-ups, and a variety of risk-bearing provider organizations including accountable care organizations, clinically integrated networks and other participants in commercial and governmental value-based initiatives, models and programs, including the Medicare Shared Savings Program and ACO REACH Model.

In addition, David advises clients in both the health care and life sciences industries on transactional and regulatory compliance matters related to health information privacy and security under the Health Insurance Portability and Accountability Act (HIPAA), the Information Blocking Rule, the Part 2 Rule, and a variety of other state and federal health data protection laws.

Bar admissionsDistrict of ColumbiaOhio

EXPERIENCE

  • Assisted internationally renowned health system renegotiate its billion-dollar relationship with a major national insurance company with respect to facilities and medical groups in multiple states, including advising on communications with regulators and patients.
  • Assisted health system in negotiating a first-of-its-kind, 50/50 joint venture with a national insurance company to operate a multi-state insurer offering commercial and Medicaid managed care products, including preparation of deal documents, administrative service agreements and organizational documents.
  • Advised publicly traded value-based provider organization on its over $130 million acquisition of a health care system's value-based care business that covers nearly 200,000 patients across the country.
  • Represented a foreign governmental health insurance program in negotiating and arranging for the coverage and care of a young child requiring a procedure solely provided in the United States.
  • Assisted national insurance company in the formation and licensure of a pharmacy benefit manager in all fifty (50) states.
  • Guided multiple health systems through the sales of their Medicare Advantage and Medicaid managed care plans, including filings with state departments of insurance and health, attorneys general offices, federal regulatory agencies, and private accreditation organizations.
  • Advised multiple accountable care organizations on day-to-day compliance matters and with respect to the use and implementation of fraud and abuse waivers and their reliance on Stark Law and Anti-Kickback Statute's value-based exceptions and safe harbors.
  • Drafted and advised on skilled nursing facility affiliate agreements for use by multiple accountable care organizations under the 3-Day Rule waiver under the Medicare Shared Savings Program and other Medicare models.
  • Assisted various risk-bearing provider organizations in assessing state licensure, registration and certification requirements with respect to value-based and other financial risk arrangements.
  • Assisted regional health plan in appealing its loss of NCQA accreditation, including gathering, reviewing and preparing documentation for the appeal process.
  • Prepared applications for certificates of authority, licensure and service area expansion and regulatory filings (such as Forms A and D) for multiple insurers and health maintenance organizations.
  • Assisted a two-state insurance company with its expansion into approximately twenty (20) states for the purpose of offering student health insurance, including drafting school agreements, certificates of coverage and related documents and preparing form and rates filings in each state.
  • Helped prepare and file a start-up insurance company’s Medicare Part D plan sponsor application, including negotiating its pharmacy benefit manager agreement.
  • Advised multiple clients (including insurers, agents, brokers and health care providers) on state insurance laws and Medicare Advantage and Medicaid managed care rules related to marketing, advertising and communications.
  • Assisted newly formed insurance company in preparation of plan documents, including certificates of coverage for health insurance exchange products.
  • Advised international insurer on compliance matters related to expatriate health plans.
  • Guided multiple covered entities and business associates through HIPAA risk assessments and data breach notifications.
  • Provided guidance to a variety of health care provider organization on a broad range of data protection matters, including HIPAA, Part 2 rule and other federal and state privacy and security laws, as well as on data sharing, ownership and use arrangements.
Education
  • J.D., Villanova University School of Law
    cum laude
  • M.A., The Ohio State University
  • B.A., Bowling Green State University
    summa cum laude

Awards

  • Ohio Super Lawyers, Healthcare "Rising Star," 2017-2020

Bylines

  • HIPAA settlement highlights the importance of caution in responding to negative online reviews, 9 January 2023
  • What healthcare providers need to know about the Contract Year 2024 proposed Medicare Advantage and Part D Rule, 5 January 2023
  • CMS releases calendar year 2023 Medicare Physician Fee Schedule Changes: key takeaways for providers, 16 November 2022
  • HIPAA guidance on disclosures relating to reproductive healthcare: Risk mitigation and strategies, 25 July 2022
  • "Health Care Privacy and Record Retention Provisions," AHLA Health Care Contracts, October 2021
  • "Accountability and Collaboration in Payer-Provider Relationships," AHLA Health Plans Contracting Handbook (8th Ed.), March 2021
  • "Hold Off on Sending That Data! First Know the Key Legal and Contractual Considerations for Sharing, Disclosing, and Processing Health Care Data," Payers Plans & Managed Care, a Publication of the AHLA, April 2019
  • "The Uncertain Future of Stop Loss Insurance in an Increasingly Self-Insured Small Group Market," Connections, Vol. 19, Issue 8, August 2015
  • "CMS Okays New Payments for Chronic Care Management," Managed Healthcare Executive, June 2015
  • "Private Payors and Other Perspectives on ACOs," AHLA Accountable Care Organization Handbook (2nd Ed.), 2015
  • "Third Party Premium Payments: Agency Memos, Rules, Litigation, and More Uncertainty," Payers Plans & Managed Care, a publication of the AHLA, April 17, 2014
  • "Is Federal Regulation the Greatest Obstacle Facing Narrow Network Exchange Plans?" Health Lawyers Weekly, Vo. XII, Issue 10, March 2014
  • "Highmark Buy Continues National Insurer Trend," Managed Healthcare Executive, June 2013
  • "Hospital-Law Enforcement Cooperation in the Emergency Department," Hospitals and Health Systems Rx, a publication of the American Health Lawyers Association, December 2010
  • "Prescription Drug Importation: A Casualty of Health Care Reform," Life Sciences, a publication of the American Health Lawyers Association, June 2010
  • "Campaign '08 and the Obama Administration's Rejuvenation of Stem Cell Research," Life Sciences, a publication of the American Health Lawyers Association, April 2009

Seminars

  • "Fundamentals of Medicare Parts C and D," AHLA Fundamentals of Health Law, November 9, 2022
  • "Legal Landmines for MCOs in the Digital Landscape and How to Avoid Them,” American Conference Institute - 13th Annual Advanced Forum on Managed Care Disputes and Litigation, March 30, 2022
  • "Fundamentals of Medicare Parts C and D," AHLA Fundamentals of Health Law, November 7, 2021
  • "Parts 1 and 2: Opportunities and Risks for Telehealth under HIPAA and State Privacy Responses to the COVID-19 Pandemic," American Telemedicine Association, COVID-19 Response Webinar Series (webinar), April 14 and 21, 2020
  • "Commercial Health Insurance and Fundamentals of Medicare Parts C and D," AHLA Fundamentals of Health Law, November 11, 2020
  • "Managed Care: An Emerging Area for Fraud and Compliance Scrutiny," Fraud and Compliance Form, September 24, 2020
  • "Fundamentals of Medicare Parts C and D and Commercial Health Insurance," AHLA Fundamentals of Health Law, November 17, 2019
  • "Getting Technical: Negotiating Your Way through the Legal Documents for Telehealth Platforms, Mobile Apps, and Other Tools," AHLA Health Plan Law and Compliance Institute, November 15, 2019
  • "Year-End Review: The Latest Trends and Issues in Health Care," December 4, 2018
  • "Fundamentals of Commercial Health Insurance and Managed Care Arrangements," AHLA Fundamentals of Health Law, November 12, 2018
  • "Sharing and Using Patient Data in Payer-Provider and Other Network Arrangements: Major Legal and Contractual Considerations," AHLA Institute for Health Plan Counsel, November 2, 2018
  • "A Legal Perspective," 2018, Advanced Payment Summit, October 23, 2018
  • "Innovative Uses of Technology in an Era of Health Care Reform," December 7, 2017
  • "Fundamentals of Commercial Health Insurance and Managed Care Arrangements," AHLA Fundamentals of Health Law, November 7, 2017
  • "Planning the Transition - Starting Your Next Generation ACO," HEA Next Generation & Advanced Risk Medicare ACO Summit in Chicago, Illinois, October 28, 2016
  • "The New Era of Discrimination Law for Health Insurance under the Affordable Care Act," AHLA Institute for Health Plan Counsel, October 27, 2015
  • "Key Health Law Issues for Non-Healthcare Lawyers," Live CLE, Ohio State Bar Association, February 19, 2015
  • "Understanding Your State’s Essential Health Benefits: A Systematic Approach," AHLA Institute for Health Plan Counsel, April 9, 2014

Prior Experience

David was Of Counsel at a major AmLaw 100 firm prior to joining DLA Piper.

Civic and Charitable

  • Member, Board of Directors, Governance Committee Chair, Local Matters, 2019-present

Memberships And Affiliations

  • Member, Program Planning Committee, American Health Lawyers Association

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