LISA A. HATHAWAY, J.D., Assistant General Counsel Blue Cross and Blue Shield of Florida 4800 Deerwood Campus Pkwy DCC 100-7 Jacksonville, Florida 32246 Direct Dial (904) 823-3468 Fax (904) 905-6208 lhathaway@bcbsfl.com Lisa Hathaway is Assistant General Counsel at Blue Cross and Blue Shield of Florida ( BCBSF ), which is headquartered in Jacksonville, Florida. BCBSF is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. BCBSF and its subsidiaries serve more than 6 million Floridians. Lisa s job responsibilities at BCBSF include legal support in the areas of ancillary, physician and hospital contracting, care management, vendor agreements, utilization review, credentialing, pharmacy, regulatory and Medicare Advantage and Medicare Part D, and appeals and grievances matters. Prior to assuming her current position at BCBSF in April 2004, Lisa was the National Director of Managed Care Contracting at Manor Care, an integrated long-term health care provider. Lisa s responsibilities included directing the Managed Care Department, which was responsible for contracting in 32 states, strategic planning and development of managed care business, legal review, analysis of regulatory matters, negotiation and maintenance of managed care contracts. From September 1993 until February 1999, Lisa was one of the legal counsel at Manor Care and provided legal support in the areas of skilled nursing, hospice, contracting, and provided oversight for large and complex collection matters. During her legal career, Lisa has also been a risk manager at Riverside Methodist Hospital in Columbus, Ohio and was a staff attorney at Baker and Hostetler law firm in Columbus, Ohio. Outside associations and activities that Lisa participates in include American Health Lawyers Association, where Lisa is the Chair of the Payors, Plans and Managed Care Practice Group. Lisa is dedicated to serving the local North Florida Chapter of the National Multiple Sclerosis Society and is both a Board member and serves as the Team Captain of the Blue Cross biking team (consisting of over 100 riders), which raised over $40,000 for the local Chapter in 2008. Lisa is also active in the local Jacksonville bar and participates in the health law section. Ms. Hathaway has been an adjunct professor at the Columbus branch of the College of Mt. St. Joseph teaching a nursing and the law class, and regularly presents on a variety of topics both nationally and locally to organizations and at seminars. She is very active in sports including bicycling, golf, swimming and kayaking. Ms. Hathaway received a B.S. in nursing, magna cum laude from University of Cincinnati in 1982 and earned her juris doctorate from University of Cincinnati in 1989. Ms. Hathaway has been licensed to practice in Ohio since 1989, and became licensed to practice in Florida in 2006.
LISA ANN HATHAWAY 1974 Glenfield Crossing Court Saint Augustine, FL PH: 904-823-3468 Cell: 904-566-7878 CURRICULUM VITAE CURRENT POSITION: Assistant General Counsel BAR MEMBERSHIP: Ohio Bar Association - November 1989 Florida Bar Association Association- January 2007 Jacksonville Bar Association- June 2004 CURRENT POSITION: Blue Cross and Blue Shield of Florida Inc. Assistant General Counsel Responsibilities include: LEGAL EXPERIENCE: Provide legal advice to clients for day to day affairs at the health plan in the areas of providers, care, quality and case management, Medicare Advantage, pharmacy and rebates and network issues. Preparation of complex contracts with providers and vendors in the areas of disease management, ancillaries, pharmacy, medical management, and Medicare Advantage and Part D. Research and interpretation of federal and state regulatory statues and rules pertaining to health plans and Medicare Advantage and Part D plans. Negotiation and settlement for complex payment issues and accounts receivable matters including negotiation and drafting settlement agreements. Provide legal support to Health Options Board of Directors in the area of appeals and grievances. Legal support for the audit and special investigation areas in regards to investigations and audits of providers and potential issues of fraud, waste and abuse. Train and educate facility employees regarding managed care, negotiation and contracting, and Medicare Advantage and Part D. HCR MANOR CARE, Toledo, Ohio National Director Managed Care Contracting - February 1999 to April 2004 Responsibilities include: Day to day management of seven employees responsible for contracting for facilities in 32 states. Direct the responsible company s managed care department; for legal review and analysis, negotiation, and maintenance of all managed care contracts for the skilled nursing facilities. Strategic planning and development of managed care business.
Problem solving with facilities and managed care organizations regarding contractual provisions, rates, accounts receivable and enrollees issues. Develop and maintain relationships with managed care organizations. Analyze regulatory enactments that affect contracts with managed care organizations. Train facility employees regarding managed care industry and contracting. Assist with coordination of managed care operations with Company s ancillary subsidiaries such as home health, therapy clinics, physician services and assisted living facilities. HCR Manor Care, Toledo, Ohio Legal Counsel September 1993 to February 1999 Responsibilities include: Provide legal advice to 67 nursing facilities in states; Draft and assist in negotiations of various types of contracts relating to nursing facilities and for corporate such as software, purchasing and equipment and leases; Review policies and procedures affecting facilities and corporate matters; nursing Prepare legal memoranda and research of federal and state laws affecting nursing facilities; Review and analyze HCFA 2567 s, prepare plans of correction, and assist in appeals and dispute resolution process; Contact outside with administrators, corporate personnel, attorneys, and department and agency personnel in matters concerning nursing facilities on a daily basis; Analyze regulatory enactments; matters and legislative Manage outside counsels' handling of litigation; Review, analyze and assist in the negotiation of insurance, HMO, PPO, network and other third party payor contracts and problem solving with denials for reimbursement and contract disputes with managed care contracts; Handle and oversee large and complex collection cases, participation in revision of corporate collection process, draft and review collection procedures, collection forms and outstanding accounts receivable and coordination of collection cases with outside counsel; Assist in corporate acquisitions, divestitures and real estate matters; and Present at regional meetings and in-services at nursing facilities on legal issues involving hospice, advance directives, the survey process documentation, admission process, managed care issues, collections, and survey and enforcement process.
Baker & Hostetler, Columbus, Ohio Staff Attorney, Litigation - May 1991 to September 1993 Responsibilities included: Participate in all phases of civil litigation, including deposing and preparing expert witnesses; Prepare documents, discovery, pleadings and briefs and assisting in trial preparation; Perform legal research and drafting motions, memorandum, documents; opinion letters and litigation Participate in editing the portion of Hospital Contracts Manual on the Peer Aspen's Review Organization; Directly interact with risk managers of hospital client Focus of practice included medical malpractice defense, workers' compensation, and health care law issues, including hospital by-laws, HIV/AIDS, OSHA Bloodborne Pathogens, fraud and abuse, certificate of need and risk management issues. Riverside Methodist Hospitals, Columbus, Ohio Assistant Director, Risk Management - March 1989 to May 1991 Responsibilities included: Participate coordinating in of the the planning, Hospital's directing and Risk Management Program; Monitor and investigate incidents and resolved problems that could potentially affect assets; Assist in purchasing insurance for the Hospital; Participate in committees such as safety, infection control and quality assurance; Provide in-services on documentation, medical records and prevention of lawsuits to hospital personnel and medical staff; Monitor outside counsel and attended depositions and trials; Analyze records for liability issues and analyzing incidents that have the potential to affect assets; and Assist in developing the Hospital's AIDS Policies and Procedures. Lane, Alton & Horst, Columbus, Ohio Summer Law Clerk - 1988 Legal research, draft memorandum, briefs and motions; and Focus of practice was defense medical malpractice. Santen, Shaffer & Hughes, Cincinnati, Ohio Summer Law Clerk - 1987 to April 1988 Legal research and draft memorandum, motions, pleadings and interrogatories; Interview clients and analyzed medical records to ascertain facts for determination of possible
claims; and Focus of malpractice. practice was plaintiff medical HEALTH CARE EXPERIENCE: University of Cincinnati Hospitals General Division, Cincinnati, Ohio Staff Nurse - June 1982 to December 1985 Float Pool Nurse - December 1986 to April 1989 Mary Jane Nursing Registry, Cincinnati, Ohio Private Duty Nursing in Homes and Hospitals and Supervisor at Nursing Homes - 1984 to 1989 City of Cincinnati Health Department, Cincinnati, Ohio Visiting Nurse in Homes and Schools - 1985 to August 1986 American Nursing Care, Cincinnati, Ohio Agency Staff Nurse in Hospitals and Nursing Homes and Private Duty Nursing - August 1982 to September 1983 TEACHING: College of Mount St. Joseph, Cincinnati, Ohio Adjunct Professor - Columbus Branch of Mount St.Joseph Taught "Health Care Law for Nurses" - 3 Credit Semester Course Winter 1999, Fall 1997, Winter 1995, Winter 1993, Winter 1992 and Fall 1990 One day seminar on health law issues for Cincinnati students; June 1996 OUTSIDE ACTIVITIES: Chair, Payors, Plans and Managed Care Practice Group for American Health Lawyers Association- July 2008-July 2011 Board Member North Florida Chapter of the National Multiple Sclerosis Society, 2009-Current Board Member North Florida Chapter of the Association of Corporate Counsel
SPEAKING ENGAGEMENTS Presentations American Health Lawyers Annual Meeting Presented for one hour session on Square Peg, Round Whole: Challenges in Post Reform Managed Care Contracting, June 28, 2010 - June 30,2010, at the in Seattle, Washington American Health Lawyers Association, Law Conference for Payors, Plans and Managed Care Providers, Presented on Untangling the Effects on Health Care Reform Legislation and Mandates on Managed Care Contracting and Payor Provider Negotiation for Plans and Providers, November 8-9, 2010, Chicago Marriott Magnificent Mile, Chicago, Illinois American Health Lawyers Annual Meeting Presented for one hour session on Advanced Issues in Payer Provider Contracting-Devil is in the Details, June 29, 2009-July 1, 2009, at the Marriott Wardman Park Hotel in Washington D.C. Medicare Advantage Strategic Business Symposium Presented two sessions: Medicare Fraud, Waste & Abuse Training: Targeting the Network Providers and Off- Shoring: Interpreting CMS Compliance Requirements October 10-20, 2009, Hyatt, Crystal City, Arlington Virginia American Health Lawyers Association, Law Conference for Payors, Plans and Managed Care Providers Presented on Advanced Contracting in a Changing Environment, October 26-27, 2009, Westin, Chicago, Illinois American Health Lawyers Association, Law Conference for Payors, Plans and Managed Care Providers, Presented on Medicare Managed Care: Hot Issues for Plans and Providers, October 13-14, 2009, the Westin Waterfront Hotel, and Boston, Massachusetts American Health Lawyers Annual Meeting Presented on Geometry of Payors, Plans and Provider Relations: Litigation and Contracting Issues, San Francisco Marriott, June 30-July 2, 2008, San Francisco, California American Health Layers Association Institute on Medicare and Medicaid Payment Issues Presented on Medicare Advantage: Network, Network and Other Contracting and Payment Out-of- Issues,, April 10, 2008, (?Location)
Medicare Advantage Summit (2 nd Annual) Presented on Medicare Advantage Private Fee for Service Plans: Compliance and Other Issues, May 21, 2008, Alexandria Virginia: Lawyers Association, Law Conference for Health Plans, Insurers and Providers Presented for two hour session on Contracting in 2007 and Beyond: Practical Solutions for New Challenges May 9-11, 2007, at the Western Diplomat in Hollywood, Florida American Health Lawyers Association Annual Meeting Presented for one hour session on Advanced Strategies for the Managed Care Boxing Arena with a co-speaker. June 25-28, 2006, at the Philadelphia Marriott Hotel, Philadelphia, Pennsylvania Blue Cross and Blue Shield Association Teleconference for Plans Presented on Tips, Legal Issues, and Lessons Learned for Part D Appeals, Grievances, and Coverage Determinations, June 1, 2006 Blue Cross and Blue Shield Association 40 th Annual Lawyers Conference Presented on Tips, Legal Issues, and Lessons Learned for Part D Appeals, Grievances, and Coverage Determinations May 3-5, 2006, California Renaissance Parc 55, San Francisco, American Health Lawyers Association Annual Meeting Presented for one hour session on Partnership Approaches to Restructuring Managed Care Contracts with a co-speaker. June 28-30, 2006, at the New York Marriott Marquis, New York, New York American Conference Institute Presented for one hour session on How to Restructure Provider Contracts in Light of the Most Recent Legislative and Regulatory Reform and one and a half hour panel presentation on What in the Future of Managed Health in America? September 29-30, 2003 at the Hyatt at Penn Square in Philadelphia, Pennsylvania American Health Lawyers Association Long Term Care and the Law Presented for two hour session on Key Areas in Long Term Care including skilled nursing, home health, hospice and durable medical equipment providers. Also presented two other sessions on Managed Care in Long Term Care: Prompt Payment and Dealing with Payment Issues. February 18-20, 2003 at the Marriott Desert Springs in Phoenix, Arizona.
American Health Lawyers Association Long Term Care and the Law and American Association of Health Plans: Managed Care Law Conference Presentation on Conflict and Consensus: An Advanced Discussion on Payor Provider Payment Disputes. May 14-16, 2003 at The Broadmoor in Colorado Springs, CO. Two sessions for lawyers, health plans, government attendees and others. American Health Lawyers Association and American Association of Health Plans: Managed Care Law Conference Presentation on Managed Care Contracting May 6-7, 2002 at The Broadmoor in Colorado Springs, Colorado One session for lawyers, health plans and other attendees American Health Lawyers Association Long Term Care and the Law Presentation on Current Issues in Managed Care Contracting February 28- March 1, 2002 in New Orleans, Louisiana For two sessions to lawyers and other attendees American Health Lawyers Association Long Term Care and the Law Presentation on Navigating the World of Managed Care Contracting February 5-7, 2001 at Aladdin Resort and Casino, Las Vegas, Nevada For two sessions to lawyers and other attendees American Health Lawyers Association Long Term Care and the Law Presentation on Nursing Facility Survey and Enforcement Process January 20-22, 1999 at Hyatt Regency Hill Country Resort, San Antonio, Texas for two sessions to lawyers and other attendees. Ohio Health Care Association Annual Convention Presentation on Avoiding the Pitfalls of Managed Care Contracting for administrators, nurses, lawyers and other attendees, May 6, 1998 in Columbus, Ohio. National Health Lawyers Association/American Health Lawyers Association Long Term Care and the Law Presentation on Avoiding the Pitfalls of Managed Care Contracting February 4-6, 1998 at Hotel Del Coronado, Coronado California for two sessions to lawyers and other attendees. Health Care and Retirement Corporation Nursing Facilities Various in-services and presentations for HCR nursing facilities throughout the country regarding documentation, advance directives, hospice, managed care, collections, OBRA regulations, survey issues and other nursing home regulations. Dayton Area Nursing Educational Consortium, Cincinnati, Ohio
"Legal Issues in Nursing Practice"; 9th Annual Medical Surgical Nursing Symposium - September 24 & 25, 1997, September 10 & 11, 1996, and September 20 & 21, 1995 Lorman Business Center Inc., Columbus, Ohio "Update on Legal Issues and HIV/AIDS and Documentation Aspects; Confidentiality of Medical Record" - November 11, 1993 Ohio State University Hospitals, Columbus, Ohio "Legal Potholes and Skid Marks"; 7th Annual Critical Care Symposium - September 28, 1993 National Association of School Nurses, Inc., Minneapolis, MN "Do Not Resuscitate"; 25th Annual Conference - June 25, 1993 Licensed Practical Nurse Association, Columbus, Ohio "Legal Aspects of Nursing in Long Term Care"; Long Term Care Conference - September 20, 1993 Business Network, Columbus & Cincinnati, Ohio "Effective Medical Records Management; Patient Care and the Law" - Summer 1993 The Ohio State University Hospitals, Columbus, Ohio "Risk Management Education" and Legal Issues in Patient - November 20, 1992 Grant Medical Center "Legal Perspective on Documentation and Communication" - September 25, 1992 Franklin University, Columbus, Ohio Guest Lecturer to Nursing Students on Torts, Informed Consent and Nurse Practice Act for Course "Legal Issues in Health Care" - Fall 1990 Ohio State University, Columbus, Ohio Guest Lecturer to Fourth Year Nursing Students on Torts, Informed Consent and Insurance for Course "Leadership and Management" - Fall 1990 PUBLICATIONS: "AIDS Update: New Bill has Widespread Implications in Health Care", Riverside Monthly - October and November 1990 "A Risk Manager's Overview of the Hobson Bill" Ohio Hospital Risk Management - Summer 1990 REFERENCES: Provided upon request.