Frank Fanshawe

Frank Fanshawe is an integral part of the Health Care Law practice in Wilson Elser’s Albany, New York office. He has practiced health care law for more than 20 years, including significant real-world legal and executive-level experience with a nationally recognized health insurer in the northeastern United States. Frank previously served as a senior adviser to the New York State Senate Health Committee chair on legislative and public policy issues in connection with New York's deregulation of the hospital payment methodology system (Health Care Reform Act) and other major health care initiatives. He also practiced law with other national law firms, where he represented hospitals, medical groups, independent practice associations, physician organizations, home health agencies and other health care providers. Frank is skilled at envisioning, constructing and executing legal and regulatory strategies that drive business results. A strong relationship and alliance builder, he understands the importance of agreement and buy-in to help ensure that workable solutions are designed in a way that most effectively addresses the unique needs of each client. Areas of Focus Corporate Governance and Compliance Frank’s in-house experience as a chief compliance officer in the health insurance industry provides him with a distinctive business and operational perspective that leads to sound governance and compliance results that work in real business settings. He counsels boards of directors on governance issues and fiduciary duties. Frank also works with clients to develop and implement corporate compliance plans, including drafting policies and procedures, directing workforce training, and auditing and monitoring programs. Frank is adept at preparing for and guiding his clients through agency audits and investigations. Health Care Law Counsel Frank has served as a trusted adviser to practitioners, boards of directors, CEOs and other C-suite executives to help clients thrive in the complex health care delivery and reform environment. He works with them to develop and improve their regulatory operations in ways that align with their business objectives. Frank counsels clients to successfully navigate the intricacies of fraud and abuse laws and regulations, helps them develop strategies to operate within the complexities of the HIPAA and HITECH regulatory framework, and works with them to obtain state licensure and certification. Frank is particularly skilled in providing context and background to help develop a thorough understanding among the practitioners and business professionals who are charged with leading in a complex regulatory environment. Commercial Contracts and Joint Ventures Frank is focused on delivering practical strategies to improve business arrangements through the negotiation and development of solid, results-oriented agreements. He negotiates major contractual arrangements and joint ventures among providers and between providers and managed care entities, including integrated delivery systems and accountable care organizations. Frank also assists clients with the regulatory and transactional aspects of joint ventures, mergers and acquisitions, and other strategic arrangements. Relying on his executive experience, Frank remains focused on striking an optimal balance between risk and business opportunity. Insurance Regulatory Counsel Frank provides strategic legal counsel on health insurance matters. With more than a decade of experience serving in-house as a senior legal, compliance and business executive with a health insurer, Frank understands the demanding regulatory environment in which health insurers, HMOs and third-party administrators operate. He counsels clients on insurance regulatory issues, including licensure, financial and reserve matters, claim payment standards, utilization review requirements, risk-sharing arrangements, provider contracting and other regulated areas. Frank has experience in both the commercial insurance and government-funded insurance markets, including Medicare Advantage and Medicaid managed care programs. Health Care Reform Frank is an accomplished leader of health care reform strategic planning teams, with experience positioning his clients to successfully operate in the rapidly changing market. He counsels clients in the areas of federal and state exchanges, securing certification as a qualified health plan, employer shared responsibility and administrative obligations, and insurance market reform. He has worked with CEOs from national and regional health plans across the nation on the strategic development of national public policy positions for health care reform. During the national health care reform debate, Frank worked side by side with members of Congress and other policymakers in developing the Affordable Care Act. Government Relations and Public Policy Frank has developed and directed federal and state lobbying and public policy initiatives in the health care and health insurance sectors. He has experience working collaboratively with stakeholders to drive meaningful public policy changes. Frank is well positioned to keep clients apprised of legislation and other public policy initiatives in New YorkState that could have an impact on their business.