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NAME AND TITLE: Daniel N. Gregoire, general counsel, executive vice president and secretary AGE: 46 THE BUSINESS: Founded in 1984, Oxford Health Plans is a public company that provides managed health care plans to employers in New York, New Jersey and Connecticut. The company, based in Trumbull, Conn., has 3,500 employees and reported 2001 revenues of $4.3 billion. It provides health care insurance to 57,000 companies and approximately 1.5 million individuals. THE LEGAL DEPARTMENT: Oxford has 14 attorneys and a support staff that puts the total legal department at about 80. The department is organized into four different groups: compliance, litigation, corporate and securities and health care regulatory and contracting. Gregoire says that, because of his corporate law background, he takes an active interest in the corporate and securities division. He works on corporate acquisitions, like the recent $18 million acquisition of the Hartford, Conn.-based MedSpan Inc., a managed care company. Gregoire also advises the board of directors on corporate matters. For example, shortly after he arrived, he worked on shifting the company’s listing from Nasdaq to the New York Stock Exchange. REGULATORY AND COMPLIANCE: Managed care companies are among the most regulated industries in the United States, and to make sure Oxford complies, the company relies on its regulatory and compliance units. The health care regulatory and contract group has six attorneys headed by Robert Moses, a senior vice president and a chief counsel. The group principally files regulatory paperwork with government insurance and health agencies. This unit also works on providers’ contracts — a key area because Oxford offers its members access to more than 50,000 participating doctors and 230,000 hospitals. The compliance group, which has two attorneys and is headed by Vice President Scott Schwartz, was initially a separate department, but was brought into the legal department by Gregoire. To ensure that the company’s policies with doctors and members meet state and federal regulations, Gregoire says the unit tries to anticipate any problems. One area of keen interest to Oxford and its peers is HIPAA — the Health Insurance Portability and Accountability Act. HIPAA, among other things, requires HMOs to protect the confidentiality and security of medical records through designated standards. “We have established within the company a HIPAA steering and implementation committee that’s at the highest level and includes myself,” says Gregoire. HMO LITIGATION: The litigation group is headed by Vice President Jonathan Rich and three other attorneys, who principally oversee outside firms handling the cases. HMOs have been the target of dozens of suits by disgruntled doctors and dissatisfied patients. Oxford is no exception and is the target of several class actions pending in state courts. In New York, a group representing 27,000 doctors is suing the state’s six largest managed care companies, claiming that alleged deceitful reimbursement policies are threatening patient care. In Connecticut, there are two separate suits pending against the major HMOs, including Oxford. In a suit similar to the one in New York, the Connecticut Medical Society, which represents 7,000 doctors, filed suit in state court against six HMOs claiming that the HMOs harmed patients by denying medical treatment and withholding payments to doctors. The suits seek damages and changes in the business practices on the part of the HMOs. A separate suit, originally filed in federal court in Connecticut by state Attorney General Richard Blumenthal on behalf of consumers, alleges that the HMOs routinely deny coverage and needed prescription drugs, conceal information, complicate the appeals process and delay payment. As part of a consolidation, that suit is now headed to Florida to join the more than 50 HMO suits being heard there by a federal judge. Gregoire says that Oxford can be distinguished from other companies in the broad swipe that plaintiffs’ lawyers have taken at the managed care business. “I would say from an industry perspective, they’re a function of a debate, a national debate really, about managed care and the desirability of managed care. But Oxford has been much more managed care ‘lite’ [than other HMOs]. As a result, we don’t feel we face the same issues that the other companies are facing that have heavy managed care,” says Gregoire. He declines to comment on the company’s litigation strategy. In its most recent 10-K filing with the Securities and Exchange Commission, Oxford said it could not predict the financial impact of the suits but said that it has “substantial defenses to the claims asserted and intends to defend the actions vigorously.” Oxford is also the target of a federal securities class action in White Plains, N.Y. The company is accused by shareholders of misleading investors about problems that led to a crash of the company’s stock. The suit is in discovery. PRODUCT DEVELOPMENT: Under Gregoire’s leadership, the legal department has joined with the marketing and underwriting departments at Oxford to form a product development team. The team comes up with new products like the “Freedom Plan,” a health plan for smaller employers that provides the same network of Oxford doctors as large member plans at a slightly higher deductible. Another product is “Oxford USA,” which allows Oxford to offer employers within the tri-state area Oxford coverage for employees who work in other states. That was achieved through the acquisition of a shell insurance company that already has the licenses Oxford would need to provide the service. “I worked on the acquisition of the insurance company — the purchase and sale agreement, the due diligence along with the outside counsel,” says Gregoire. PRIMARY OUTSIDE COUNSEL: For corporate and securities matters and some litigation, Sullivan & Cromwell in New York; for additional litigation, Robinson & Cole in Hartford, Conn. For a majority of the regulatory matters, LeBoeuf, Lamb, Greene & MacRae in New York and Connecticut. Oxford also has a pool of six to eight other firms for regulatory and litigation matters in the tri-state area. Gregoire says his philosophy about outside counsel is to collaborate and oversee closely. “We don’t try to do the outside lawyers’ work, but effectively work as a team,” he says. ROUTE TO THE TOP: Gregoire earned an undergraduate degree in 1978 and a law degree in 1981 from Boston University. He worked for Sheehan Phinney Bass + Green in Manchester, N.H., for the next 20 years, specializing in corporate health care law. He joined Oxford in December 2000 because of his relationship with Oxford CEO Norman Payson. Prior to joining Oxford, Payson founded Healthsource Inc., an HMO, which Gregoire had represented. FAMILY: He and his wife, Ellen, have two children, Jason, 17, and Scott, 14. They live in Auburn, N.H., but soon will move to Trumbull, Conn., to be near Oxford. LAST BOOK READ: “Eisenhower: Soldier and President,” by Stephen E. Ambrose.

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