HELAINE I. FINGOLD is a Member of the Firm in the Health Care and Life Sciences practice, in the Baltimore office of Epstein Becker Green. She has more than 28 years of broad health law and regulatory experience, including prior government experience in both the legislative and executive branches of the federal government.
- Advises on issues involving the Medicare Program Parts A, B, C, and D, Medicare Innovations, Medicare Dual Eligibles, Medicaid, and Veterans' health care programs
- Counsels on federal and state regulation of products offered on public and private health insurance exchanges
- Provides interpretative and practical advice on oversight and compliance requirements of the Medicare Advantage and Medicare Prescription Drug programs, including on star ratings, marketing, program audits, network adequacy, reporting standards, and more
- Advises plans, vendors, and providers on Medicare Part C risk adjustment, including with respect to overpayment, enforcement, RADV audit preparation, coding and documentation guidance, and compliance with Medicare regulations
- Counsels companies on legislative and regulatory strategies involving government health programs including health insurance reform
Prior to rejoining the firm, Ms. Fingold worked at the Centers for Medicare & Medicaid Services' ("CMS's") Center for Consumer Information and Insurance Oversight (CCIIO) in the Exchange Policy and Operations Group. As both a Senior Technical/Policy Lead and as the Acting Director, Rates & Benefits Branch, Division of Plan Management, Ms. Fingold was responsible for defining and interpreting requirements relating to the qualification of qualified health plans and stand-alone dental plans in both state and federally-facilitated exchanges, oversight of these plans, essential health benefits, and market-wide cost sharing limitations.
From 2004 to 2012, Ms. Fingold worked in a range of capacities at CMS with responsibility for areas of the Medicare Advantage program, including plan application review and approval, application denials and appeals, contracting, plan surveillance, oversight, and marketing. She also is experienced in the Medicare Advantage and Prescription Drug audit and sanction process.
Ms. Fingold began her professional career as an attorney in the Office of the General Counsel of the Department of Health and Human Services assigned to CMS's predecessor agency on legal issues arising under Medicare Parts A and B and Medicaid. Ms. Fingold then was a team lead within Office of Research and Demonstrations at CMS's predecessor agency, working on Medicaid waiver and Medicaid demonstration programs. She later spent two years as a health care attorney in the DC office of Epstein Becker Green. Ms. Fingold left the firm to serve as General Counsel for the Medicare Payment Advisory Commission before rejoining CMS in 2004.
- Northeastern University School of Law (J.D., 1991)
- University of Massachusetts (B.A., 1987)
- District of Columbia
- American Health Law Association
- District of Columbia Bar Association
- Maryland Bar Association