Mr. Oakley is one of the leading health insurance and HMO lawyers in New York. Over the past 25 years he has been involved in nearly every aspect of health insurance in New York, particularly at the legislative and regulatory levels. He has represented many of the largest health plans in their New York operations, especially with regard to HMO licensure, premium rates and underwriting, and all aspects of managed care. Mr. Oakley was extensively involved in New York's creation of mandated community rating and an open enrollment system, as well as the associated risk adjustment process among health plans, and was extensively involved in the drafting and administration of New York’s “file and use” system of premium regulation. That expertise has led to frequent involvement in litigation, such as the U.S. Supreme Court's groundbreaking decision in the Travelers case upholding state surcharges from ERISA preemption, and many successful challenges to regulatory overreaching, such as court rulings against the New York State Insurance Department’s efforts to limit insurers’ rights to establish premium rates. In particular, Mr. Oakley works extensively on all aspects of payment rates for health care services, including associated issues of claims administration and coding to obtain the appropriate rate. He is best known for his work on the technical details of DRG inpatient hospital systems, outpatient rates, incorporation of quality measures into payment rates, creation of community reimbursement systems such as global budgets and regional input into health care system structure. He was involved in helping create the current Health Care Reform Act system of negotiated hospital rates by private payors which includes mandated surcharges on hospital claims, assessments on the number of covered lives, and special payments for graduate medical education. His clients range from the largest hospitals in the State to the smallest hospital in New York. His work has also included advocacy for medical malpractice reform. |