David Oakley

Profile

David Oakley is one of the leading health care reimbursement lawyers in New York. Over the past 35 years he has been involved in nearly every aspect of health care payments in New York, particularly at the legislative and regulatory levels. He is best known for his work as the lead attorney for all legal, regulatory and contracting issues to establish one of the largest Medicare Pioneer Accountable Care Organizations. His representation includes expanding that ACO to contract with the full range of all payors, including Medicaid Managed Care plans and self-insured plans. David also represents hospital systems creating direct-to-employer clinically integrated networks, similar to ACOs. David has an extensive practice in determining which payment arrangements are regulated as assuming insurance risk and which payment methods are not. He also represents health homes and clients seeking to integrate health homes into provider-led care coordination.

David works extensively 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 structures. He represents numerous large hospitals, but also represents specialty hospitals and one of the smallest hospitals in the state.

David was involved in helping create New York’s Health Care Reform Act (HCRA) system of negotiated hospital rates by private payors which includes state-mandated surcharges on hospital claims, assessments on the number of covered lives, and special payments for graduate medical education. His unique knowledge of rate issues has led to frequent involvement in litigation, such as the U.S. Supreme Court’s groundbreaking decision in the Travelers case upholding state rate surcharges from ERISA preemption.

David previously 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. His extensive knowledge of the payor world provides insights that most health care attorneys representing providers of care do not have. For many years he has been extensively involved in the details of premium rate regulation, with a particular focus on assisting insurers to explain and justify their proposed premium increases, as well as navigating the regulatory and political process surrounding premium increases. That work has included 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.

Publications

Contributor, “NYC PHIP Small Practice Project, Final Report,” United Hospital Fund, June 2018.

Co-author, “Antitrust Issues Under the New York DSRIP Process,” NYSBA Health Law Journal, Sept 2016, Vol. 21, No. 2.

“HMO Liability for Malpractice of Member Physicians: The Case of IPA Model HMOs,” Torts and Insurance Law Journal, Spring 1988.

06.14.18

NYC PHIP Small Practice Project, Final Report

Primary care practices in New York face pressure from payers and regulators to transition to a medical home model and to participate in value-based ...

10.24.17

Understanding New York State’s Proposed Single Payer Bill

By James Lytle, Partner, Manatt Health, Government and Regulatory | David Oakley, Counsel, Manatt Health ...

09.15.16

Antitrust Issues Under the New York DSRIP Process

The unfolding process in the New York Medicaid Delivery System Reform Incentive Payment Program (DSRIP), the work of the resulting regional ...

03.25.19

New York Health Act: Summarizing the Proposed Single-Payer Bill

The proposed New York Health Act would replace all private and public (including Medicare and Medicaid) health insurance coverage for New York State ...
03.25.19

Managing Antitrust Risks in ACOs, IPAs, CINs and PHOs

The key antitrust statute is Section 1 of the Sherman Act, which prohibits two types of agreements that unreasonably restrain competition.
02.25.19

ACOs, IPAs, CINs, PHOs: Legal Issues Behind the Acronyms

Much of the terminology around provider networks is confusing and overlapping. Part of the confusion stems from different terminology being used in ...
01.23.19

Now on Demand: ACOs, IPAs, CINs, PHOs: Legal Issues Behind the ...

What’s in a name? There is considerable overlap in the nature and goals of the “alphabet soup” of network ...

01.09.19

ACOs, IPAs, CINs, PHOs: Legal Issues Behind the Acronyms

What’s in a name? There is considerable overlap in the nature and goals of the “alphabet soup” of network ...

David Oakley

Senior Counsel

Manatt Health

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