Adam Hepworth

Adam J. Hepworth is an associate and health care business lawyer with Foley & Lardner LLP. His practice focuses on Medicare and Medicaid, internal audits and investigations, health privacy laws, and compliance with health care fraud and abuse laws.

Adam has represented hospitals, Federally Qualified Health Centers (FQHCs), and other providers in Medicare and Medicaid appeals, including Medi-Cal provider audit appeals.He has assisted health systems with internal and government investigations, overseen audits with outside consultants and statisticians, and advised on repayment obligations.

He has also counseled clients on developing integrated models of care that are compliant with federal and state health privacy laws, including HIPAA and the federal substance-use-disorder privacy regulations at 42 CFR Part 2.

Adam has significant experience working with health care providers to comment on proposed federal and state rules and legislation, including comments addressing Medicaid managed care, Medicare reimbursement cuts, CMS Innovation Center models, the 340B Drug Pricing Program, the federal substance-use-disorder privacy regulations, Knox-Keene licensing requirements, and FQHC reimbursement.

Prior to joining Foley, Adam was a law clerk for Judge Harris L Hartz on the United States Court of Appeals for the Tenth Circuit.

Education :

Adam received his law degree from Stanford Law School (J.D., 2013), where he was co-editor-in-chief of the Stanford Journal of Law, Science & Policy and a student fellow at the Center for Law and the Biosciences.

Adam received his bachelor’s degree, Phi Beta Kappa and with distinction, from Stanford University (B.A., 2009). He was also awarded interdisciplinary honors in the Ethics in Society program.

Admissions and Professional Memberships :

Adam is admitted to practice in California. He is a member of the American Health Lawyer’s Association and the Los Angeles County Bar Association’s Health Law Section.

Representative Matters :

• Foley represented Care 1st Health Plan, a California Medicaid and Managed Care HMO, and its shareholders in the share of stock to Blue Shield of a California for $1.2 Billion.
• Foley counseled a digital health company regarding privacy laws and restrictions on the use of patient health information in connection with marketing communications. Foley assisted the company in determining what types of communications it could deliver under HIPAA and whether or not patient authorizations were required in the various scenarios.
• Foley assisted a large telehealth company with operations across multiple states to understand and comply with new and enhanced Medicaid managed care enrollment requirements for physicians and other practitioners. Foley’s advice helped the company more effectively negotiate with Medicaid managed care plans and ensure continued eligibility and revenue within the plans’ networks.
• Foley advised a telehealth provider in connection with its contract development and state reimbursement analysis to develop partnerships with school-based clinics, increasing access to primary care for children while at school. Foley’s advice included strategies for affiliating with Federally Qualified Health Centers and ensuring compliant Medicaid reimbursement for services.