Adam Hepworth

Corporate, Health Care

Adam J. Hepworth’s practice focuses on Medicaid and Medicare, administrative appeals, health privacy laws, and compliance with health care fraud and abuse laws. He is a partner in the firm’s Health Care and Life Sciences Sector.

Adam has represented hospitals, Federally Qualified Health Centers (FQHCs), DME suppliers, and other providers in numerous Medicaid administrative appeals. He argued Tulare Pediatric Health Care Center v. State Department of Health Care Services, resulting in a decision from the California Court of Appeals recognizing the state’s obligation to pay FQHCs a Medi-Cal per-visit rate that reflects their full costs when they contract with an outside medical group.

Adam has written, presented, and counseled clients on how to navigate federal and state health privacy laws — including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the federal substance use-disorder privacy regulations at 42 C.F.R. Part 2 — when developing integrated models of care that address the social determinants of health. Adam has special expertise advising California public hospitals, health plans, and hospital authorities on complex health care issues at the intersection of local government law and federal and state health care programs, including prosecuting and defending writs of mandate. He has also worked on state legislation addressing FQHC reimbursement, health privacy, managed care network adequacy, clinic licensure, hospital authority governance, telehealth, Medicaid supplemental payments, and behavioral health delivery systems.

Adam has often assisted health care providers to comment on federal and state rules addressing Medicaid managed care, Medicaid and Medicare reimbursement, HIPAA, the federal substance use-disorder privacy regulations and Knox-Keene licensing requirements.

Prior to joining Foley, Adam was a law clerk for Judge Harris L. Hartz on the 10th Circuit U.S. Court of Appeals.

Past Chair, Health Law Committee of the California Lawyer’s Association

Member, California Society for Health Care Attorneys

Member, American Health Lawyer’s Association

Member, Los Angeles County Bar Association (Health Law Section)

Secured a court decision overturning a state Medicaid’s agency’s denial of an FQHC’s change in scope of services request, allowing the community clinic to receive a significantly higher prospective payment system rate.

Secured dismissal of writ of mandate against county behavioral health plan alleging inadequate mental health network.

Settled Medi-Cal public hospital cost report appeals to restore tens of millions of dollars of costs disallowed during state audits.

Provided strategic advice on legislation addressing Medi-Cal behavioral health financing and payments, specialty mental health network adequacy, and Behavioral Health Services Act requirements.

Assisted provider association to draft state legislation modernizing Medicaid enrollment and reimbursement policies for telehealth clinic services.

Counseled multistate health system through internal audit, investigation, and OIG self-disclosure of overpayments caused by noncompliance with Medicare and Medicaid regulatory requirements.

Investigated, self-disclosed to CMS, and resolved health system Stark violation involving numerous physician lease arrangements across multiple hospitals and campuses.

Advised county public health department on creation of integrated care teams to serve clients impacted by health care, housing, and justice issues, including development of policies and procedures for sharing protected information.

Counseled nonprofit health system on the implementation of a hospital-at-home program, including evaluation of temporary Centers for Medicare & Medicaid Services (CMS) waivers, fraud and abuse laws, scope of practice limitations, and corporate practice prohibitions.

Provided specialized Medicaid counsel in due diligence for national durable medical equipment (DME) transaction involving Medicaid enrollment and reimbursement in multiple states.

Stanford University

Bachelors

Stanford Law School

Juris Doctor