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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 and Washington insurance and health care lawyer, Peter D. Ricoy focuses his legal practice in insurance regulation, health care law, data security and privacy, long term care regulation, and general corporate and business transactions. Mr. Ricoy works with insurers, health plans, physicians, group practices, coordinated care organizations, independent practice associations, hospitals, patient safety organizations, assisted living facilities, and employers. He advises clients on a variety of matters, including issues related to the Oregon Insurance Code, 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 with an insurance company, and 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

Insurance Regulatory Matters
• Former Associate General Counsel with Cambia Health Solutions, a health care company housing several insurance company subsidiaries collectively serving more than two million members in the Pacific Northwest/Intermountain region, including Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah, Regence BlueShield (in select Washington counties), and Asuris Northwest Health.
• Extensive experience analyzing the application of the Oregon insurance code to various provider risk-sharing arrangements.
• Represented insurance clients in response to Market Conduct Inquiries from the Insurance Division.
• Drafted form insurance policies and applications for insurance clients, including Affordable Care Act "Qualified Health Plans", and life settlement contracts.
• Assisted clients drafting, submitting and obtaining approval for "Form A" filings 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.
• 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.

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.
• Represented hospital district in the sale of its hospital to a larger regional nonprofit hospital system.
• 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.
• Regularly draft and negotiate physician employment agreements, shareholder agreements, admission agreements, and termination agreements.
• 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
• Successfully represented client in response to an Office of Civil Rights investigation in response to a self-reported data breach
• 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 technical experience in working with, understanding, and analyzing large, multidimensional data sets.

Long Term Care
• Successfully represent assisted living and memory care facility obtain licensure from Oregon Department of Human Services.
• Guided clients through all aspects of senior housing regulations in Oregon, including licensing requirements, change of ownership for assisted living and residential care facilities, change of administrators, change of Medicaid contract, and change in management entity.
• Advised clients on regulatory aspects involved in assisted living M&A deals

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.

Professional & Community Activities
Mr. Ricoy participates or serves with the following organizations:
• Treasurer and Member of Board of Governors, City Club of Portland
• 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, Advisory Committee of the Latino Partnership Program, Oregon Community Foundation
• 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, Aligned Incentives, and New Payment Models," Oregon State Bar 2014 Health Law Section Annual CLE, Sunriver, OR, October 24, 2014 (forthcoming).
• "HIPAA and HITECH Act Fundamentals," American Bar Association Health Law Section, National Webinar, August 14, 2014
• "Clinical Integration, the Alignment of Incentives, and CMS Quality-Based Payment Programs," Adventist Health Managers Network, July 15, 2014
• "Clinical Integration, Health Care Information, and the Alignment of Incentives," Schwabe, Williamson & Wyatt Client Breakfast Presentation, Portland, Oregon, May 14, 2014
• "CMS Quality Based Payment Reform Initiatives, Health Care Compliance Association," San Diego, CA, April 1, 2014
• "Health Care Issues in M&A Transactions," Schwabe, Williamson, & Wyatt Presentation, Portland, Oregon, March 23, 2014
• "Coordinated Care Organizations: a Deeper Look at Selected Issues," Willamette University Health Law Class Presentation, Salem, OR March 17, 2014
• "Cyber Security Risk For Business Today," Luminant Digital Security, Beecher Carlson, & Schwabe, Williamson & Wyatt sponsored presentation, Portland, OR January 28, 2014.
• "Managed Care Fundamentals," American Bar Association Health Law Section, National Webinar American Bar Association Health Law Section, January 23, 2014
• "Health Reform Impacts: Focus on Employers," Regence BlueCross BlueShield of Oregon Employer Summit, Portland, OR, September 19, 2013.
• "Transacting Business Amidst Rapid Regulatory Reform," Hispanic National Bar Association Annual Conference, Denver, CO, September 6, 2013.
• Health Law Notes – Business Associate and Breach Reporting Changes, Healthcare Privacy & Security Forum, Lake Oswego, OR, July 18, 2013.
• "Oregon's Health Insurance Exchange in 2014," Oregon Ambulatory Surgery Center Association Conference, November 8, 2012.
• "Impact of the Supreme Court's Health Care Decision," Schwabe, Williamson, & Wyatt sponsored client event, Portland, Oregon, June 28, 2012.
• "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 Cross Blue Shield Association Blue National Summit, Chicago, IL, December 4-7, 2011.
• "Employer-Provided Health Insurance in 2014 and the Health Insurance Exchange," Portland Metropolitan Payroll Association, October 19, 2011.
• "Employer-Provided Health Insurance in 2014 and the Health Insurance Exchange," Associated Builders and Contractors Seminar, Portland, OR September 22, 2011.
• "How the New Federal Health Care Law Will Affect the Business Community," Hispanic National Bar Association, 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.

Language
Mr. Ricoy speaks 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
University of Michigan, Master of Public Policy degree
University of Michigan, Bachelor of Arts degree

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


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