Frank Stevens

Managing Director

Franklin Stevens is a managing director in the Health Analytics practice at Berkeley Research Group, LLC (BRG). Mr. Stevens applies his thirty-nine plus years of senior leadership, operations experience, and strategy expertise to assist state and federal regulators, health plans, hospitals, physicians, ancillary providers, lenders, counsel, and state and federal courts regarding managed care litigation, strategy development, and implementation regarding industry policy changes, financial and operational improvement, turnaround and insolvency matters, forensic investigations, and alleged state regulatory, Medicaid, and Centers for Medicare and Medicaid Services’ (CMS) regulatory noncompliance, including CMS regulations specific to Medicare Advantage Marketing Guidelines, labor and human resource issues, third-party administration, reinsurance, and workers compensation matters.

Monitor, Conservator, Trustee, and Responsible Person Experience

  • Appointed by the California Department of Managed Health Care (DMHC) 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 Shield, Care First, and LA Care as independent monitor of two different delegated entities.
  • Appointed conservator of three health plans by the DMHC to assume control of health plan operations that were noncompliant, and for which management and the board had failed to resolve the issues. Two appointments resulted in the turnaround of the health plans.
  • At DMHC’s request, led multiple routine and nonroutine examinations of health plans using a combined team of state auditors and members of Mr. Stevens’ health plan team.
  • For the three conservatorships, reviewed and issued decisions for more than five thousand payment disputes via a proof of claims process created with the approval of the California Superior Court. All payment decisions made in his role as conservator were approved by the court, and none of his decisions were overturned or modified.
  • 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 more than ten companies. The reason given for replacing management and ownership was their desire to have someone who could be trusted to be fair, equitable, and reasonable to oversee the 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 to liquidate assets and managed multiple litigations in state and federal districts across the US specific to errors made by government intermediaries.
  • Served as the number-two executive for engagements where BRG Managing Director Mark Abernathy was named monitor or conservator of health plans, most recently Alameda Alliance for Health, where he spent two years fixing the health plan for the DMHC.

Industry Experience

  • Thirty-nine plus years of managed care experience, including the negotiation of payer contracts with hospitals in forty-two states (California since 1987) for inpatient and outpatient services using per diems, DRGs, percentage of charges, fee schedules, and capitation.
  • Ten years of experience calculating the impact of the renewals of payer-hospital agreements provided to three hundred claims payers, including health plans, insurance companies, and TPAs for self-funded employers 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 federal Eastern District of Pennsylvania specific to class action settlements between plaintiffs and defendants.

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