Roy brings significant health care experience to his practice, including knowledge of the Medicare program, federal regulations, and fraud and abuse laws.
Roy represents health care payors and providers on a wide range of regulatory, compliance, and transactional matters. He advises Medicare Advantage organizations and prescription drug plan sponsors, pharmacy benefit managers, and Medicaid managed care organizations on matters addressing reimbursement and billing, compliance, audits, enforcement actions, programs for individuals who are dually eligible for Medicare and Medicaid, and recent statutory and regulatory developments. He has provided health care regulatory counsel, such as due diligence, licensing, change of ownership, certification, and contracting services, within the context of mergers and acquisitions to both purchasing and selling entities, including Fortune 500 companies.
Roy regularly counsels on new initiatives and demonstrations conducted by the Centers for Medicare & Medicaid Services (CMS) and States. For example, he has worked with multiple clients on the application and contracting requirements, and regulatory and compliance standards part of the Financial Alignment Demonstration. The Financial Alignment Demonstration requires CMS, States, and health plans to enter three-party agreements and provide integrated care for dual eligible individuals.
Roy also advises hospitals, laboratories, home health agencies, skilled nursing facilities, hospices, other facilities, and practitioners about fraud and abuse laws (including the Stark Law, the Federal Anti-Kickback Statute, the False Claims Act, and various state laws), reimbursement, and compliance matters.
Prior to joining Mintz Levin, Roy worked at CMS, where he provided policy, legal, and financial analysis relating to overpayments, the Stark Law, and other laws, regulations, and agency guidance. In addition to CMS, Roy has served in various other roles within the US Department of Health & Human Services, including the Office of Medicare Hearings and Appeals and the Office of the General Counsel.
During law school, he was editor-in-chief of The Business Lawyer, a journal published by the American Bar Association. He is admitted to practice law in Maryland and the District of Columbia and is a member of the American Health Lawyers Association.
Recognitions & Awards
- William P. Cunningham Award, University of Maryland School of Law
Professional & Community Involvement
- Member, American Health Lawyers Association
Roy brings significant health care experience to his practice, including knowledge of the Medicare program, federal regulations, and fraud and abuse laws.
Roy represents health care payors and providers on a wide range of regulatory, compliance, and transactional matters. He advises Medicare Advantage organizations and prescription drug plan sponsors, pharmacy benefit managers, and Medicaid managed care organizations on matters addressing reimbursement and billing, compliance, audits, enforcement actions, programs for individuals who are dually eligible for Medicare and Medicaid, and recent statutory and regulatory developments. He has provided health care regulatory counsel, such as due diligence, licensing, change of ownership, certification, and contracting services, within the context of mergers and acquisitions to both purchasing and selling entities, including Fortune 500 companies.
Roy regularly counsels on new initiatives and demonstrations conducted by the Centers for Medicare & Medicaid Services (CMS) and States. For example, he has worked with multiple clients on the application and contracting requirements, and regulatory and compliance standards part of the Financial Alignment Demonstration. The Financial Alignment Demonstration requires CMS, States, and health plans to enter three-party agreements and provide integrated care for dual eligible individuals.
Roy also advises hospitals, laboratories, home health agencies, skilled nursing facilities, hospices, other facilities, and practitioners about fraud and abuse laws (including the Stark Law, the Federal Anti-Kickback Statute, the False Claims Act, and various state laws), reimbursement, and compliance matters.
Prior to joining Mintz Levin, Roy worked at CMS, where he provided policy, legal, and financial analysis relating to overpayments, the Stark Law, and other laws, regulations, and agency guidance. In addition to CMS, Roy has served in various other roles within the US Department of Health & Human Services, including the Office of Medicare Hearings and Appeals and the Office of the General Counsel.
During law school, he was editor-in-chief of The Business Lawyer, a journal published by the American Bar Association. He is admitted to practice law in Maryland and the District of Columbia and is a member of the American Health Lawyers Association.
Recognitions & Awards
- William P. Cunningham Award, University of Maryland School of Law
Professional & Community Involvement
- Member, American Health Lawyers Association
Publications
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Co-author,
2014 Final Call Letter: CMS Raises Medicare Advantage Rates but Foreshadows Other Significant Program Changes, Health Law Advisory ()
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Co-author,
Managing an Integrating Care for Vulnerable Populations: The Financial Alignment Demonstrations to Support State Efforts to Integrate Care, Payors Plans & Managed Care ()
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Co-author,
Medicare Star Ratings—What Plan Sponsors Need to Know, BNA’s Medicare Report ()
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Co-author,
Recovery Audit Contractor (RAC) Audits: Are Plan Sponsors Ready?, Compliance Today ()
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Co-author,
Fiscal Year 2013 Work Plan Highlights OIG’s Medicare Parts C and D Priorities, Health Law Advisory ()
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Co-author,
Supreme Court Health Care Ruling: Preliminary Analysis & Implications Going Forward, Health Law | Employee Benefits | ML Strategies Alert ()
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Co-author,
CMS and OIG Issue Joint Notice, Solicit Comments Related to Waivers of Fraud and Abuse Provisions for Accountable Care Organizations, Health Care Reform Alert ()
Speaking Engagements