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Health Plans & Other Insurers

Practical Know-How for a Rapidly Shifting Market

​Health plan providers and other insurers face constant pressure to minimize costs and increase innovation. In a highly regulated industry, being able to manage these roadblocks — while remaining compliant at both the state and federal levels — requires guidance from experienced counsel. Our attorneys are steeped in your industry. We have many years of experience including as in-house counsel for a large managed care organization and in senior government positions.

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Our Experience

Case Study
Mintz has worked with both Medicare Advantage Organizations and Part D plan sponsors across the United States to assist them in offering MA-PD and Part D EGWPs. Mintz attorneys help these clients submit applications to CMS, ensure compliance with CMS guidelines, and resolve ERISA issues.
Case Study
Mintz has represented multiple health plans seeking to contract with the Centers for Medicare & Medicaid Services (CMS) to offer Medicare Advantage Plans, Part D Plans, or both. Mintz attorneys assist health plans with the CMS application process, notices of deficiencies, and application denials.

Our Approach

Our team serves as a trusted advisor to health plans across the country, in the commercial, Medicare Parts C and D, and Medicaid spaces. We have deep experience counseling these entities on the full range of complex legal, regulatory, and legislative issues. We have unique depth of experience and knowledge of Medicare Advantage organizations and Medicare Part D plans and we routinely work with these entities on the various program requirements.

Comprehensive Capabilities
  • Fraud, waste, and abuse issues, compliance, and enforcement
  • Demonstration projects and other federal and state initiatives
  • Provider and administrative contracting and subcontracting
  • Reimbursement, pricing, and billing matters
  • Marketing, beneficiary protection, and quality of care inquiries
  • Statutory and regulatory analyses of program participation requirements
  • Audits (including Medicare “program” audits, risk adjustment data validation audits, and Medicaid audits)
​Experience Where It Matters
  • Former general counsel for Medicaid and Medicare programs at UnitedHealth Group
  • Former president, National Association of Medicaid Fraud Control Units (NAMFCU)
  • Former general counsel for America’s Health Insurance Plans (AHIP)
  • Former Director and Supervising Attorney, Oregon Department of Justice Medicaid Fraud Control Unit (MFCU)
  • Various personnel from Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General (OIG)
  • Former chair, Massachusetts Rate Setting Commission

Meet Mintz

​Our attorneys serve as trusted advisors to health plans across the country in the commercial, Medicare Parts C and D, and Medicaid spaces.