Adam J. Hepworth

Senior Counsel

Overview

Adam J. Hepworth is a senior counsel and health care lawyer with Foley & Lardner LLP. His practice focuses on Medicaid and Medicare, internal audits and investigations, health privacy laws and compliance with health care fraud and abuse laws. He has been recognized by Chambers USA: America’s Leading Business Lawyers:

Adam Hepworth is a walking encyclopedia of healthcare regulations.”

He is a delight to work with and we feel very confident in his advice and counsel.”

Adam has represented hospitals, Federally Qualified Health Centers (FQHCs) and other providers in numerous Medicaid administrative appeals. He argued Tulare Pediatric Health Care Center v. State Department of Health Care Services, resulting in a decision from the California Court of Appeals recognizing the State’s obligation to pay FQHCs a Medi-Cal per-visit rate that reflects their full costs when they contract with an outside medical group.

Adam has written, presented and counseled clients on how to navigate federal and state health privacy laws—including HIPAA and the federal substance-use-disorder privacy regulations at 42 CFR Part 2—when developing integrated models of care that address the social determinants of health. He has also helped clients pursue reimbursement opportunities available for innovative delivery systems under Medicaid waiver programs and advanced payment models.

Adam has often assisted health care providers to comment on federal and state rules addressing Medicaid managed care, Medicaid and Medicare reimbursement, the 340B Drug Pricing Program, HIPAA, the federal substance-use-disorder privacy regulations and Knox-Keene licensing requirements. He has also worked on state legislation addressing FQHC reimbursement, telehealth, Medicaid waiver programs and mental health delivery systems.

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.

Representative Matters

  • Administrative Appeals. Secured a court decision overturning a state Medicaid’s agency’s denial of an FQHC’s change in scope of services request, allowing the community clinic to receive a significantly higher prospective payment system rate.
  • Legislative Drafting. Assisted provider association to draft state legislation modernizing Medicaid enrollment and reimbursement policies for telehealth clinic services.
  • Overpayments and Self-Disclosures. Counseled multi-state health system through internal audit, investigation, and OIG self-disclosure of overpayments caused by noncompliance with Medicare and Medicaid regulatory requirements.
  • Social Determinants of Health. Advised county public health department on creation of integrated care teams to serve clients impacted by health care, housing, and justice issues, including development of policies and procedures for sharing protected information.
  • Innovative Hospital Delivery. Counseled nonprofit health system on the implementation of a hospital-at-home program, including evaluation of temporary CMS waivers, fraud and abuse laws, scope of practice limitations, and corporate practice prohibitions.
  • Medicaid Compliance. Provided specialized Medicaid expertise in due diligence for national durable medical equipment (DME) transaction involving Medicaid enrollment and reimbursement in multiple states.

Recognition

  • Received, Best Lawyers: Ones to Watch recognition for Health Care Law (2021 - 2022)
  • Recognized, Chambers USA, Healthcare (2020 - 2021)

Education

  • Stanford Law School (J.D., 2013)
    • Co-editor, Stanford Journal of Law, Science, and Policy
    • Student fellow, Center for Law and the Biosciences
  • Stanford University (B.A., with distinction, 2009)
    • Phi Beta Kappa
    • Interdisciplinary Honors, Ethics in Society

Admissions

  • California

Professional Memberships

  • Member, California Society for Health Care Attorneys
  • Member, American Health Lawyer’s Association
  • Member, Los Angeles County Bar Association (Health Law Section)

Selected Publications and Presentations

  • Author, “Episode 16: Community Health Centers: Issues Facing FQHCs Today,” Health Care Law Today & Health Care Law Today Podcast (July 27, 2021)
  • Co-author, “Payment Dispute with a Medicaid Health Plan? State Not Obligated to Help, According to Federal Court,” Health Care Law Today (July 14, 2021)
  • “Federally Qualified Health Centers (FQHCs) – Overview and Emerging Issues,” Presentation to AHLA Educational Call (April 9, 2021)
  • Co-author, “Congress Requires New Reporting for States That Make Medicaid Supplemental Payments,” Health Care Law Today (February 23, 2021)
  • “Diving Deeper into the Revised Stark and Kickback Rules,” Foley & Lardner Webinar Presentation (January 26, 2021)
  • Co-author, “New HHS Board Will Hear 340B Drug Pricing Disputes,” Health Care Law Today (December 15, 2020)
  • “Social Determinants of Health: Use of Medicare and Medicaid Funds,” Presentation to County Counsel’s Association of California’s Health and Welfare Fall 2020 Study Section Meeting (October 29, 2020)
  • “Digging Deeper in Your Audits: An Investigative Approach to Effective Compliance, the 60-day Rule, and Identifying Overpayments,” Presentation to AHLA Virtual Fraud and Compliance Forum (September 29, 2020)
  • Co-author, “Patient Records: Part 2 Final Rule Reduces Substance Use Disorder Record Sharing Barriers,” Health Care Law Today (July 15, 2020)
  • “Medicaid Payment Reform – Uncertain Future of Supplemental Payments,” Presentation to American Health Law Association (May 5, 2020)
  • Co-author, “COVID-19: CARES Act Overhauls Federal Substance Use Disorder Privacy Law,” Foley's Coronavirus Resource Center & Health Care Law Today (March 26, 2020)
  • Co-author, “FQHCs: Practical Impacts of Governance Requirements,” Health Care Law Today (January 8, 2020)
  • Co-author, “FQHCs: Four Reimbursement Traps for the Unwary,” Health Care Law Today (December 9, 2019)
  • Co-author, “CMS Proposed Enhanced Scrutiny over Medicaid Supplemental Payments,” Health Care Law Today (November 20, 2019)
  • Co-author, “FQHCs: The Nuts and Bolts of Medicaid Reimbursement,” Health Care Law Today (November 13, 2019)
  • Co-author, “Five Tips for Contracting with Federally Qualified Health Centers,” Health Care Law Today (November 7, 2019)
  • Co-author, “Proposed Changes to Part 2 Rules Ease Substance-Use Disorder Record Sharing,” Health Care Law Today (August 27, 2019)
  • “Yes, We Can Share Behavioral Health Data: Common Misconceptions and Barriers to Information Exchange,” Presentation at Michigan Health Information Network Legal Summit (June 3, 2019)
  • Co-Author, “DC District Court Holds that Medicare Payment Cuts for 340B Drugs Exceeded Agency’s Authority,” Health Care Law Today (January 8, 2019)
  • “Substance Use Disorder Privacy Laws: Navigating Federal and State Requirements,” Presentation at Health Care Compliance Association, San Francisco Regional Conference (November 30, 2018)
  • “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)
  • Co-author, “California: Proposed Legislation Regulating Health Care Rates for Payors and Providers,” Health Care Law Today (April 19, 2018)
  • Co-author, “California Medicaid Agency Proposes Significant Restrictions on FQHC and RHC Reimbursement,” Health Care Law Today (March 13, 2018)
  • Co-author, “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)
  • “Ninth Circuit Victory Opens the Door to Medicaid Reimbursement Challenges Based on Equal Access Requirement,” AHLA Bulletin (August 23, 2017)

Capabilities