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Peter Ricoy - Healthcare Attorney - Portland, Oregon

Peter D. Ricoy

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503-796-2973 Direct
pricoy@schwabe.com

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Professional Experience
As an Oregon health care lawyer, Peter D. Ricoy focuses his legal practice in health care law, data security and privacy, insurance regulation, and general corporate and business transactions. Mr. Ricoy works with health plans, physicians, group practices, hospitals, insurers, and employers. He advises clients on a variety of matters, including issues related to health care reform under the 2010 Patient Protection and Affordable Care Act (PPACA), the Stark and Anti-Kickback Statutes, Medicare, Medicaid, reimbursement, HIPAA, COBRA, and ERISA health plan matters. Mr. Ricoy has worked with a number of insurance companies on regulatory matters related to understanding requirements, rate and form approvals, and company and product registrations. Previously, Mr. Ricoy was Associate General Counsel for Cambia Health Solutions (an independent licensee of the Blue Cross and Blue Shield Association), where he was the dedicated attorney supporting the Sales and Actuarial & Underwriting departments and advised clients on a variety of health care and insurance matters.

Mr. Ricoy previously served as a Health Care Economist who supervised a team of analysts researching health care data and financial information to enhance efficiencies. In addition, Mr. Ricoy worked for KPMG as a Consultant and Fiscal Policy Advisor to the Parliament of Ukraine, where he spent two years helping to successfully establish the country's first fiscal analysis office and train its staff. He has a background in economics, policy analysis, and econometric modeling, and also served for three years as a Tax and Budget Analyst for the U.S. Congressional Budget Office in Washington, D.C.

Relevant Experience and Knowledge Areas

Health Care
• Drafted form provider, commercial accountable care organization (ACO) agreements, and coordinated care organization (CCO) agreements.
• Represented a large health insurer in analyzing the impact of health care reform on its operations and implement appropriate changes.
• Drafted and negotiated administrative service only (ASO) agreements, stop-loss contracts, contingent premium, wellness agreements, and other alternative funding agreements between fully-insured and self-funded ERISA plans and health insurance companies.
• Drafted physician and third party administrators (TPAs) group practice agreements and joint ventures in a manner to avoid Stark and Anti-Kickback Statute prohibitions.
• Guided client through Medicare regulations related to "incident to" supplies and services and supervision requirements to ensure client eligibility for appropriate level of Medicare reimbursement.
• Represented a large multispecialty clinic convert from a Limited Liability Partnership to a Professional Corporation without disrupting Medicare reimbursement.
• Represented physician in hospital dispute concerning revocation of privileges under Medicare's change of ownership (CHOW) regulations.
• Provided guidance to physician group on physicians' rights under Oregon law to create medical liens and collect amounts owed to the physicians.
• Drafted hospital facility lease agreement between hospitals.
• Reviewed antitrust considerations pertaining to data dissemination and sharing agreement between health care entities.

Data Security & Privacy
• Regularly advises clients on matters related to HIPAA privacy, security, and data breach responses.
• Advised patient safety organization on matters related to regulatory requirements, data security, and de-identification requirements.
• Drafted data license agreements.
• Former economist with considerable tecnical experience in working with, understanding, and analyzing large, multidimensional data sets.

Insurance
• Assisted client to draft and submit "Form A" statements with Oregon Insurance Division.
• Drafted and negotiated producer (agent and broker) agreements between producers and insurance companies.
• Assisted clients to obtain rate and form approvals with the Oregon Insurance Division, including individual and group health plans, annuity filings, life insurance filings, and automobile insurance filings.
• Drafted form policies for clients, including life settlement contracts.
• Obtained regulatory approval for client to operate as a licensed Life Settlement Provider in Oregon.
• Represented captive insurance company in securing eligibility to transact business in several states, including Oregon, Washington, Wyoming, and Utah.
• Represented insurance producer in the sale of insurance accounts and related business.

General Business
• Conducted entity formations and drafted related corporate documents, including bylaws, operating agreements, subscription agreements and shareholder's agreements.
• Served as the lead attorney in an asset purchase agreement for a client in the acquisition of a machine shop business.
• Determined applicability of Gramm-Leach-Bliley Act and drafted client's privacy notice.

Presentations
• "Health Reform Impacts: Focus on Employers," Regence Employer Summit, Portland, OR (September 19, 2013)
• "Oregon's Coordinated Care Organizations: A Deeper Look at Selected Issues," Adventist Health Portland, Health Managers Network, Portland, OR (April 26, 2012)
• "Oregon's Coordinated Care Organizations," 2012 Oregon Ambulatory Surgery Center Association Community Care Organizations Seminar, Portland, OR (March 21, 2012)
• "Health Reform Update," City of Corvallis seminar sponsored by Beecher Carlson, Corvallis, OR (January 2012)
• "What Makes My Blue Plan Special? Insurance Requirements Inside and Outside the Health Care Exchanges," 2011 Blue National Summit, Chicago, IL (December 4-7, 2011)
• "How the New Federal Health Care Law Will Affect the Business Community," HNBA 2011 Annual Convention, Dallas, TX (September 1, 2011).
• "Health Care Reform and the Advent of the Health Care Exchanges in 2014," Seminars sponsored by Schwabe, Williamson & Wyatt and Beecher Carlson (July/September 2011).
• "Accountable Care Organizations and Oregon's Coordinated Care Organizations: Preliminary Look at Proposed Regulations and the New Law," Oregon State Bar Health Law Section Brown Bag Lunch CLE, Portland, OR (June 2011).

Professional & Community Activities
Mr. Ricoy participates or serves with the following organizations:
• Vice-Chair, eHealth Privacy & Security Interest Group, ABA Health Law Section
• Vice-Chair, Distance Learning Committee, ABA Health Law Section
• Immediate Past President, Oregon Hispanic Bar Association
• Past Chair and current member, Health Law Section of the Oregon State Bar
• Member, Board of Directors of Oregon Hispanic Bar Association
• Member, American Bar Association, Health Law Section
• Member, Hispanic National Bar Association
• Member, Oregon Health Lawyers Association
• Member, American Health Lawyers Association
• Member, Oregon Minority Lawyers Association

Speaking Engagements
• Clinical Integration, the Alignment of Incentives, and CMS Quality-Based Payment Programs, July 15, 2014
• Clinical Integration, Health Care Information, and the Alignment of Incentives, May 14, 2014

Language
Mr. Ricoy is fluent in Spanish.

Other Activities and Interests
Mr.Ricoy is a third degree black belt in Tae Kwon-Do, and volunteers as an instructor at the Woodstock Community Center in Portland. He also enjoys bicycling and spending time with his spouse and three children.

Admitted to Practice
Oregon State Courts
Washington State Courts

Education
Lewis & Clark Law School, Juris Doctor degree, cum laude (2005)
University of Michigan, Master of Public Policy degree (1994)
University of Michigan, Bachelor of Arts degree (1992)

Articles
Marketing Under the HIPAA Megarule: The Rules Become Tighter, May 1, 2013


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