Frank Stevens

Frank Stevens brings more than 43 years of comprehensive managed care and health care experience to his role as a Managing Director in the BRG Health Analytics practice. The scope of his experience includes engagements with health plans, hospitals, academic medical centers, physician groups, Federally Qualified Health Center (FQHC) organizations, regulatory agencies, and state and federal courts. Mr. Stevens has been appointed as investigative monitor, conservator of health plans, trustee of a financial settlement, and responsible person in the bankruptcy court.

An abbreviated summary of his experiences includes:

• Appointed by the California Attorney General as the independent monitor for the Cedars-Sinai affiliation with Huntington Hospital Pasadena.
• Appointed by the California Department of Managed Health Care and Department of Health Care Services as the independent monitor on five occasions to monitor health plans, delegated entities of health plans and provider organizations.
• Appointed by health plans including Blue Cross Blue Shield, Care First, LA Care as their independent monitor of two different delegated entities.
• Appointed conservator of three health plans by the California Department of Managed Health Care to assume control of health plan operations who were non-compliant, and management and the board had failed to resolve the issues. Two of these appointments resulted in the turnaround of the health plans.
• Recruited by the health plan and provider community of Southern California to accept the role of responsible person in the Central District Federal Court for the KPC Chaudhuri insolvency involving approximately thirteen companies.
• Appointed trustee of a settlement trust with estimated $100 million in assets specific to a hospital cost report company, its three lenders and provider creditors. Managed the company retained by the lenders and creditors to liquidate assets as well as managed multiple litigations in state and federal districts across the US specific to errors made by government intermediaries.

Industry Experience

• 43 plus years of managed care experience including the negotiation of payer contracts with hospitals in 42 states (California since 1987) for inpatient and outpatient services using per diems, DRGs, percent of charges, fee schedules, and capitation.
• 10 years of experience calculating the impact of the renewals of payer-hospital agreements provided to 300 claims payers including health plans, insurance companies, and TPAs for self-funded employers and Taft Hartley Trust including The Walt Disney Company, General Mills, Coors Brewing, and Darden Restaurants.
• Recognized by California State Superior Courts, Federal Court jurisdictions in California and Pennsylvania, and arbitrations in California as an expert in managed care contracting, the calculation of payments, and the application of contract reimbursement terms, utilization management terms, and benefit design in the determination of reimbursement amounts for claims submitted by hospitals.
• Provided “Fairness Opinion Reports” to both California State Superior Court and the Eastern District of Pennsylvania specific to class action settlements between plaintiffs and defendants.

Mr. Stevens is currently focusing his practice on independent monitoring engagements involving regulatory compliance and/or compliance with agreed upon settlements including anti-trust settlements specific to acquisitions of health care organizations. He also serves as a consulting expert in managed care litigation cases.