Mediator Resume

Self Employed - Mediator and Arbitrator

Attorney, Mediator, Arbitrator

Sole ADR Practitioner, 2012 - present; Senior Counsel, Partridge Snow & Hahn, LLP, 2012; President and Chief Executive Officer/Chief Operating Officer, Blue Cross & Blue Shield of Rhode Island, 2000 - 2011; Founding Partner, Managing Partner and Chair of Litigation Department, Partridge Snow & Hahn LLP, 1988 - 2000; Partner/Associate, Tillinghast Collins & Graham, 1980 - 1988.

Health Care and Insurance: Focused on disputes involving integrated healthcare systems, reimbursement disputes, and a broad scope of insurance matters. As a practicing trial lawyer, was completely immersed in virtually all aspects of healthcare, and was COO and CEO of Blue Cross & Blue Shield of RI (BCBSRI) for 12 years. Retired 1/1/12, and focused solely on ADR. Am knowledgeable regarding Accountable Care Organizations. Am appreciative of the balances and nuances in the payor/provider world, and have been involved in disputes and negotiations of that sort for three decades. Am experienced in facilitation resolution of stalled contract negotiations amongst providers and insurers. Represented BCBSRI in negotiation and drafting of provider contracts and self insurance agreements as well as AFA and TPA contracts. As a Blue CEO, was a board member of the Blue Cross and Blue Shield Association and attended quarterly board meetings with the other Blue CEOs. Was actively involved in Committees of the Blue Cross National Association such as its Health Policy and Legislative Committee, Emerging Issues Committee, and the Administrative Committee. Was past board member of Blue Health Intelligence, the operational data warehouse created by the Association for Blues - probably the largest health care data warehouse in the world at the time. Also was a past board member of BCS Financial, a "captive" D&O, E&O and stop loss insurer located in Chicago and chair of its Investment Committee, and a board member of Plans' Liability Insurance Company, also located in Chicago. Was Chair of the Board of Directors of the Rhode Island Quality Institute (RIQI), a C-suite board of health care executives in RI. Testified before Congress in favor of Behavioral Health Parity Legislation. Was the recipient of the Providence Business News 2005 Business Excellence Award for Individual Business Leadership in Rhode Island and multiple other community leadership awards. Chaired 8th Annual World Healthcare Congress Plans Summit in 2011. Chaired the Marcus Evans First ACO Payor Leadership Summit in September, 2014 and was a featured speaker on ACO/Insurer relationships. Business Torts and Unfair Competition Cases: Was involved as advocate in a full range of cases alleging bad faith, breach of fiduciary duty, Massachusetts' ch. 93A claims, unfair competition, etc. Corporate Governance, Compliance, Ethics, and Fiduciary Duty Matters: Became CEO of BCBSRI at a time of controversy, and became expert in Corporate Governance, Compliance, etc. Lived through six years of creating what has been described as the best ethics and compliance program experts had ever seen. Chaired a number of other boards of large organizations and understand the interrelationships between Boards and C Suites.

As a former business executive (COO and CEO of Blue Cross & Blue Shield of RI ("BBSRI")), and as a former practicing trial lawyer representing clients in mediations as advocate, and now as ADR neutral, brings a unique combination of experience and style to mediations. Having been a client helps to understand the client's needs in a way that builds trust and credibility, which in turn facilitates settlement. As a charter member of the United States District Court for the District of Rhode Island ADR Panel, conducted mediations and early neutral evaluations (perhaps 10) from 1995 until 2000 when became employed by BCBSRI. The cases were varied in size and subject matter, but success rate was 90%. As a practicing litigator, participated in many substantial commercial mediations representing clients. As COO and later CEO of BCBSRI, has participated in mediations, and conducted own "informal" mediations between and amongst members of the Rhode Island health care community, helping them to resolve differences. A significant portion of responsibilities as CEO was mediating disputes amongst my Vice Presidents and others in the health care community. Since retirement from BCBSRI in 2012, have mediated approximately 20 significant disputes since retirement from Blue Cross in 2012. Most of these were in healthcare and insurance matters, although several were in basic contract disputes, construction disputes, and professional corporation dissolutions. Member of the AAA Commercial Mediation Panel.

Payor/Provider disputes of varied types including: - Medical necessity and length of stay disputes between payor and hospital system - Miscoding disputes between labs and providers - Pharmacy coding issues Contract disputes between providers and suppliers/healthcare supply general contracting agents Dissolution of professional partnerships/corporations Billing issues regarding pathologist practices Two matters involving patent/trademark disputes between US company and Chinese companies with interpreters

Preparation is key. As a mediator, if I do not understand and appreciate the business relationships between the parties, I am less likely to devise possible solutions that the parties themselves have not considered. Mediation is a process designed to make the parties more amenable to settling a dispute. Thus, earning the credibility and trust of both the advocates and their clients is equally important. The emotional aspect of settlement must be respected. I expect the parties to submit reasonably short position papers and exchange them. At the mediation, counsel for each side would argue their case with the opposing party (decision maker) present. This is one of the most important elements, because the decision maker will hear how effectively opposing counsel makes their case. That in and of itself makes parties a bit more amenable to settle. There would be a question and answer period, and then I would separate the parties, conferring with each privately to give them my view of strengths and weaknesses, and as the circumstances dictate, my view of possible approaches to settlement. Particularly where there is an ongoing relationship between the parties, my job as mediator is to find a mutually satisfactory resolution that may go beyond the bounds of the immediate dispute. Each party has to give something, but be able to leave the mediation feeling they were treated respectfully and fairly; that they had their day in "court," and that while not entirely happy with the settlement, it is acceptable. At the appropriate time in a mediation, I evaluative (I let the parties know what I think). The key is to apply pressure in a professional, respectful, and empathetic way to move the parties toward "yes." I would consider recessing and resuming in a week or two, if it would give the parties the opportunity to further consider their course of action.

Available for both in-person and remote arbitrations. Have handled Zoom mediations and arbitrations.

Cornell University (AB, History - 1967); Boston University Law School (JD, magna cum laude - received the Dr. John Ordronaux Award for "Member of the Graduating Class With the Most Exemplary Academic Performance and Leadership" - 1974 ).

Admitted to the Bar: Maine (1974); Rhode Island (1980); Massachusetts (1985).

Rhode Island Bar Association; American Arbitration Association (member of Commercial and Health Panels), American Health Law Association (member and arbitration and mediation panelist); Massachusetts Dispute Resolution Services.

Numerous speaking engagements in present past position as President and CEO of BCBSRI; 10/10: Presenter at AAA first Healthcare Symposium in Chicago regarding ADR in healthcare disputes; 12/11: speaker at Blue Health Summit in Chicago regarding use of new AAA Payor/Provider Rules in disputes; 12/11: opening speaker at AHLA healthcare law seminar in Chicago; Op ed series in Providence Business News commencing Oct. 2013, on Seizing Healthcare Reform Opportunities. Opening speaker at Opal Events Risk Management Conference, Jacksonville, FL, on Apr. 24, 2014. Chair and Featured Speaker at the First ACO Payor Leadership Summit (Marcus Evans) in Atlanta on Sept. 11-12, 2014; Speaker at Employer Health Benefits Congress, Wash. DC., Sept. 23, 2014; ABA Dispute Resolution Spring Conference, April 16, 2015, Seattle, WA, "ADR in Healthcare Disputes From the CEO's Perspective"; American Association of Legal Nurse Consultants Educational Forum 2015, April 17, 2015, Indianapolis, IN, "Why Alternative Dispute Resolution is Critically Important in Resolving Healthcare Disputes".

Providence, RI and Boston, MA

Hourly Rate: $600.00 Daily Rate: Not provided Study Rate: $600.00/hr Cancellation: Not provided Cancellation Period: Not provided Comment: Including preparation time and expenses.

English

United States of America

Hyannis, Massachusetts