When clients need help understanding the federal and state regulation of health insurance, and identifying and addressing related barriers and opportunities, they turn to Helaine Fingold. Clients benefit from Helaine’s experience working at both the Centers for Medicare & Medicaid Services and the Medicare Payment Advisory Commission (MedPAC), which has given her keen insight into how regulators interpret and apply the laws, regulations, and related administrative processes regarding Medicare, Medicaid, and commercial insurance.
Her clients range from small start-ups to large corporate entities with multiple subsidiaries. They include Medicare Advantage, PACE, Medicaid, and other managed care plans; provider entities; vendors to providers and managed care companies (including administrative support entities, providers of software and online services, agents/brokers/field marketing organizations, and advertising/marketing entities).
Helaine’s practice focuses largely on the regulation of Medicare managed care (including Medicare Advantage, Part D, dual eligibles, PACE, demonstrations), Medicaid managed care, commercial managed care products (including surprise billing), and behavioral health (including mental health parity).
Helaine helps clients:
- understand and address state licensure rules that apply to their business;
- develop and submit Medicare Advantage, Qualified Health Plan, and other managed care applications for qualification;
- respond to deficiencies in Medicare Advantage applications;
- appeal the denial of a Medicare Advantage application;
- challenge and get withdrawn federally issued compliance notices for allegedly failing to comply with Medicare Advantage regulations and guidelines;
- identify and correct noncompliance with Medicare managed care laws and regulations;
- identify health regulatory compliance risks in potential investments through due diligence reviews;
- understand applicable rules, and appeal Medicare star ratings; and
- understand and interpret the new federal law on surprise billing, including areas for potential regulatory governance.
Before building her private practice, Helaine gained 20 years of experience in the federal government: 13 years at CMS, working on Medicaid, Medicare Advantage/Part D, and ACA implementation, and seven years at MedPAC. During her time at CMS, she was part of the team that implemented the Medicare Advantage program prior to its rollout in 2006. She also worked with the team that implemented the Affordable Care Act requirements applicable to federal and state health care marketplaces, qualified health plans, and individual and small group commercial insurance. Helaine’s government experience also included serving as General Counsel for the Medicare Payment Advisory Commission.