|J.D., 2002, Arizona State University College of Law|
|B.S., 1999, Arizona State University|
|U.S. District Court, District of Arizona|
|American Health Lawyers Association|
Based in the firm's Phoenix office, Darryl has substantial experience representing health insurers and plans, health care providers and other health care entities on a state and national level.
With extensive knowledge in health care and insurance law, Darryl has represented several of the most prominent managed care companies, Medicare Advantage organizations and Part D sponsors in the country as both in-house and outside counsel. He advises managed care and other clients on all types of regulatory and transactional matters, including federal and state licensing and enforcement, compliance program development and implementation, provider network development and leasing, and health plan product development. Darryl has significant experience negotiating provider network access agreements between leased networks and self-funded plans and other third party payors. He regularly provides counsel in negotiating payor/provider and health care administrative services agreements, and in resolving reimbursement and other disputes with contracted and non-contracted providers.
Darryl also represents hospitals and other health care providers in a wide array of regulatory and transactional matters, including structuring joint ventures and contractual arrangements, compliance program development and implementation, and medical staff and peer review issues.
Prior to joining the firm, Darryl served as Executive Counsel for one of the largest health insurers in the country, where he was responsible for managing all legal matters for its Medicare Advantage and Part D program and one of its commercial health plan divisions. He has also been in-house counsel for a national leased provider network and a litigator for health plans in provider reimbursement and other disputes.
- Represented a healthcare company in creating innovative new joint venture ownership structure for in vitro fertilization labs, leveraging best of breed technologies and best practices through licensing and management systems. Researched and created innovative corporate and business structure achieving business priorities while addressing competing requirements in areas of corporate, tax, insurance, consumer finance, and health care, including restrictions on corporate practice of medicine, fee splitting, self-referral, and anti-kickback.
- Catholic Healthcare Mercy West Gilbert Medical Center v. PacifiCare of Arizona, Inc., Arbitrated issue of whether Medicare-based reimbursement under an MA Plan contract includes capital costs for "new hospital" when paid on a cost basis and not prospectively under the IPPS Pricer, and issue of the application of Hall Street to standard of judicial review of arbitration awards in Arizona.
- Advised Medicare Advantage organizations and Part D sponsor in the successful remediation of marketing and enrollment sanctions imposed by the Centers for Medicare and Medicaid Services (CMS). Represented Medicare Advantage organization in due diligence, regulatory approval and contract novation process related to membership sale transaction.
- Advised Medicare Advantage organizations in preparing for and responding to risk adjustment data validation (RADV) audits by the Centers for Medicare and Medicaid Services (CMS).
- Advised Medicare Advantage organizations and Part D sponsor in developing sales and marketing programs in compliance with the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
- Advised health plans in developing and implementing compliance programs for Medicare Advantage, Part D and commercial health plans.
- Represented health plans in implementing the requirements of the Patient Protection and Affordable Care Act (PPACA).
- Represented health plans in operations and finance audits by state insurance regulators, including development and implementation of audit deficiency corrective action plans (CAPs).
- Advised health plans and health plan administrators on outsourcing and offshoring of services under the Medicare and Medicaid programs.
- Represented health plans in negotiating provider network participation agreements with hospitals and other providers.
- Represented health plans in reimbursement disputes with contracted and non-contracted hospitals and other providers, including with respect to reimbursement under Medicare and Medicaid.
- Represented provider network leasing entity in structuring and negotiating network lease and managed care services agreements with self-funded payors, commercial health plans, and third party administrators (TPAs).
- Advised health plan in licensing and other health plan requirements for new market expansion.
- Advised health plans in product development and sales, including preparation of coverage documents and marketing materials.
- Represented hospital and other providers in structuring and negotiating physician and physician group contracts, joint ventures, and other arrangements in compliance with federal and state physician self-referral and anti-kickback laws.
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