David E. Kopans
David Kopans focuses his practice on the representation of clients in the healthcare and health insurance industries. His experience includes advising on insurance licensure (including licensure for third party administrators and pharmacy benefit managers), formation and operation of health insurance companies and health maintenance organizations, insurance regulatory filings, managed care contracting and provider network licensure/registration and clinical integration.
David’s experience also includes advising hospitals, health systems and other healthcare providers on hospital-physician alignment strategies; healthcare fraud and abuse; health information privacy compliance; regulatory, operational and compliance matters; physician and vendor contracting; Medicare/Medicaid participation and compliance; and licensure and accreditation.
- Author, “Prescription Drug Importation: A Casualty of Health Care Reform,” Life Sciences, a publication of the American Health Lawyers Association, May 2010.
- Co-author, “Campaign ’08 and the Obama Administration’s Rejuvenation of Stem Cell Research,” Life Sciences, April 2009.
- Co-author, “Highmark Buy Continues National Insurer Trend,” Managed Healthcare Executive, June 2013.
- Advising on a wide range of matters specifically related to healthcare reform under the Patient Protection and Affordable Care Act or “Obamacare,” including the employer mandate and related issues, essential health benefits (and impact on state mandated benefits), mental health parity rules, internal appeals and external review policies and procedures, summary of benefits and coverage (SBC) preparation and compliance, minimum loss ratio (MLR) compliance and strategy, and other matters.
- Guiding an insurance plan through the qualified health plan certification process to offer individual and small group products on Ohio’s health insurance exchange or marketplace.
- Drafting member handbooks, evidence of coverage, insurance contracts and insurance applications, for compliance with Obamacare as well as state insurance law.
- Representing health plans and providers in managed care contract negotiations and drafting.
- Helping a health system enter into a joint venture with a national insurance company to form and to co-own a health insurance company that is licensed as a health insurer and a health maintenance organization.
- Assisting in acquisitions of health insurance companies, including Medicare Advantage plans and Medicaid managed care organizations.
- Conducting multistate licensing applications of insurance companies and insurance agents, including third-party administrators and pharmacy benefit managers.
- Representing managed care organizations, including PPOs and a PACE organization, in drafting provider participation agreements and advising on statutory and regulatory compliance.
- Preparing insurance regulatory filings, such as Forms A, B and D and similar filings.
- Negotiating services agreements with and on behalf of carriers, TPAs, PBMs and other vendors.
- Preparing accountable care organization provider participation agreements and advising on compliance for the same.
- Counseling hospitals, hospices, physicians and other healthcare organizations in matters such as healthcare fraud and abuse and health information privacy compliance; contractual arrangements; regulatory, operational and compliance matters; Medicare/Medicaid participation and reimbursement; and licensure and accreditation.
Villanova University, J.D., cum laude, 2008The Ohio State University, M.A., 2004Bowling Green State University, B.A., summa cum laude, 2002