Adam J. Hepworth

Adam J. Hepworth is often referred to as a “walking encyclopedia” by his clients. His expertise lies in advising hospitals, federally qualified health centers and other providers on matters such as Medicaid administrative appeals, overpayment investigations and navigating health privacy laws to address the social determinants of health. Hepworth’s contributions to the field extend beyond his legal practice, as he is also recognized as a thought leader, having published articles and actively worked on California legislation related to Federally Qualified Health Center reimbursement, Medicaid, telehealth and health care privacy.

At Foley & Lardner, Hepworth and his team have been working closely with multiple local government entities to establish integrated care teams that cater to individuals affected by a broad range of health care, housing, food insecurity, poverty and justice issues. Their advisory work encompasses privacy concerns, data sharing, compliance and governance structures, negotiations with private partners and vendors and the development of authorization forms and program policies and procedures.

“There is an increasing policy focus on addressing the social determinants of health in addition to the more narrow health care needs of patients, which requires coordination between traditional providers and other community members and government agencies,” Hepworth said. “We particularly see the importance of this focus for safety net populations who may face barriers accessing nonmedical resources that are often prerequisites for effective health care (e.g., housing, transportation, food). The health care field is still playing catch up in redesigning payment models and delivery systems to align with these ambitious policy goals.”

Hepworth played a significant role in a major victory secured by Foley & Lardner in a federal court in California. The firm challenged the Secretary of the U.S. Department of Health and Human Services’ approval of a California state plan amendment that imposed substantial Medicaid rate cuts and burdensome pre-authorization requirements for specific services provided by specialty dental hygienists. These changes adversely affected seniors in numerous facilities and the hygienists serving them, making it logistically or financially unfeasible, and sometimes both, to provide essential periodontal services. After thorough legal arguments and presentations, the Foley team obtained a court order from the U.S. District Court for the Central District of California to invalidate the contested provisions of the state plan amendment.

“In the matter involving my representation of multiple government entities, many of these local government initiatives raise novel legal issues because they are at the cutting edge of efforts to address the social determinants of health and promote whole-person care,” Hepworth said.

In addition to his legal practice, Hepworth actively participates in various professional associations, holding positions such as vice chair of the California Lawyer’s Association Health Law Committee and membership in the California Society for Health Care Attorneys, American Health Lawyer’s Association and the Los Angeles County Bar Association’s Health Law Section.