Adam J. Hepworth

Associate

Overview

Adam J. Hepworth is an associate and health care business lawyer with Foley & Lardner LLP. His practice focuses on Medicare and Medicaid, internal audits and investigations, health privacy laws, and compliance with health care fraud and abuse laws.

Adam has represented hospitals, Federally Qualified Health Centers (FQHCs), and other providers in Medicare and Medicaid appeals, including Medi-Cal provider audit appeals. He has assisted health systems with internal and government investigations, overseen audits with outside consultants and statisticians, and advised on repayment obligations. He has also counseled clients on developing integrated models of care that are compliant with federal and state health privacy laws, including HIPAA and the federal substance-use-disorder privacy regulations at 42 CFR Part 2.

Adam has significant experience working with health care providers to comment on proposed federal and state rules and legislation, including comments addressing Medicaid managed care, Medicare reimbursement cuts, CMS Innovation Center models, the 340B Drug Pricing Program, the federal substance-use-disorder privacy regulations, Knox-Keene licensing requirements, and FQHC reimbursement.

Prior to joining Foley, Adam was a law clerk for Judge Harris L Hartz on the United States Court of Appeals for the Tenth Circuit.

Education

Adam received his law degree from Stanford Law School (J.D., 2013), where he was co-editor-in-chief of the Stanford Journal of Law, Science & Policy and a student fellow at the Center for Law and the Biosciences.

Adam received his bachelor’s degree, Phi Beta Kappa and with distinction, from Stanford University (B.A., 2009). He was also awarded interdisciplinary honors in the Ethics in Society program.

Admissions and Professional Memberships

Adam is admitted to practice in California. He is a member of the American Health Lawyer’s Association and the Los Angeles County Bar Association’s Health Law Section.

Selected Publications and Presentations

  • “Recent Trends and Hot Topics in Healthcare: Unraveling the ACA,” Presentation to Association of Corporate Counsel (August 7, 2018)
  • “42 CFR Part 2 and Integrated Models of Care,” Presentation to Florida Hospital Association (March 28, 2018)
  • “California Medicaid Agency Proposes Significant Restrictions on FQHC and RHC Reimbursement,” Health Care Law Today (March 13, 2018)
  • “SAMHSA Finalizes Second Round of Changes to Federal Substance Use Disorder Privacy Rule,” Health Care Law Today (January 11, 2018)
  • “Administrative Enforcement Tools,” Health Law Handbook, 2017 Edition (2017)
  • “Medicaid Reimbursement Update,” Presentation to County Counsels’ Association of California (November 17, 2017)
  • “Battling the Opioid Epidemic: A Legislative Update,” ACC Docket, Vol. 35, No. 8 (October 1, 2017)
  • “Health Care Reform Returns to the Spotlight,” Health Care Law Today (September 18, 2017)
  • “Ninth Circuit Victory Opens the Door to Medicaid Reimbursement Challenges Based on Equal Access Requirement,” AHLA Bulletin (August 23, 2017)
  • “Proposed Rule Would Slash Medicare Payment for 340B Drugs,” Health Care Law Today (July 20, 2017)
  • “Senate Releases Repeal and Replace Legislation on ACA: The Better Care Reconciliation Act of 2017,” Health Care Law Today (June 27, 2017)
  • “SAMHSA Proposes Major Changes to Federal Substance Abuse Privacy Rule,” Health Care Law Today (February 9, 2016)
  • “Potential Part B Drug Payment Cuts for 340B Hospitals,” Health Care Law Today (January 19, 2016)
  • “New Guidance Outlines Requirements for State Innovation Waivers,” Health Care Law Today (December 17, 2015)
  • “Court Strikes Down 340B Orphan Drug Rule Again: Will This Impact the “Mega Guidance?” Health Care Law Today (October 19, 2015)
  • “CMS Proposes Major Update to Medicaid Managed Care Regulations,” Health Care Law Today (May 28, 2015)

Representative Matters

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Foley represented Care 1st Health Plan, a California Medicaid and Managed Care HMO, and its shareholders in the share of stock to Blue Shield of a California for $1.2 Billion.
Foley assisted a large telehealth company with operations across multiple states to understand and comply with new and enhanced Medicaid managed care enrollment requirements for physicians and other practitioners. Foley’s advice helped the company more effectively negotiate with Medicaid managed care plans and ensure continued eligibility and revenue within the plans’ networks.
Foley advised a telehealth provider in connection with its contract development and state reimbursement analysis to develop partnerships with school-based clinics, increasing access to primary care for children while at school. Foley’s advice included strategies for affiliating with Federally Qualified Health Centers and ensuring compliant Medicaid reimbursement for services.

Capabilities