Practice

Cynthia Marcotte Stamer helps health care providers and payers, life sciences, DME, health technology, and other health industry clients to manage legal risks and improve operational effectiveness through her work as an attorney for health industry clients, her leadership in health industry organizations, and committed health care advocate.

For nearly 20 years, Cindy has advised health and managed care payers, providers, governmental agencies and leaders, and others about risk management, compliance, operations, employment, employee benefit, investigations and public policy concerns impacting the health care industry. Known for her high accessibility and ability to respond to triage crisis and other emergent legal and business concerns, Cindy acts as outside operations and special counsel to a broad range of health care providers, payers, and other health industry clients. She represents health care providers, managed care and insurance organizations, health plans, plan sponsors, plan fiduciaries and others before federal and state regulators and assists them to respond to regulatory and enforcement changes. Her clients include public and private health care providers, health and other insurance benefit plans and plan sponsors, health plan fiduciaries, and their technology, administrative services, and other vendors. She also regularly conducts training for health and insurance industry clients on a wide range of topics.

Cindy’s background includes a lengthy resume of advising clients about federal and state health care, tax, insurance, employment, privacy, and other regulations and policy. She also regularly works with health industry clients on credentialing; licensing; human resources and staffing concerns; outsourcing and referral; contracting; patient empowerment and consumer directed health care; claims administration and processing; delegation; utilization management and quality; health care and health program product, process and technology design and administration; patient, provider, payer and beneficiary relations; privacy and security; investigations; internal controls; and other legal, management and operational matters. As effective management of internal and external staff and other human resources are critical to the effective conduct of many of these activities by health industry clients, Cindy maintains an in-depth knowledge and pragmatic understanding of these legal complexities for which is Board Certified in Labor and Employment Law by the Texas Board of Legal Specialization.

As a continuous part of this work, Cindy works extensively on federal and state prompt pay, ERISA, Medicare, Medicaid, and other payment and reimbursement regulations. She works extensively with health industry providers to legally maximize reimbursement under public and private health benefit programs while minimizing false claim and other liabilities. She also advises payers and plan sponsors to design, document, administer, and defend health benefit programs, provider and other vendor agreements, claims investigation and administration procedures, and other related practices to promote operational objectives and comply with applicable federal and state laws.

Recognized in International Who's Who of Professionals and bearing a Martindale Hubble AV-rating, Cindy also is recognized for her leadership and scholarship in the health industry. Cindy’s experience includes leadership of health industry organizations. She serves on the Board of Directors, and as Compliance Committee Chair of the National Kidney Foundation of North Texas. She previously served as the Chairman of the Board and President of Richardson Development Center for Children, a early childhood intervention agency. Cindy also serves as the Chair of the American Bar Association (ABA) Health Law Section Managed Care & Insurance Interest Group, the Chair of the ABA RPPT Section Welfare Plan Committee, on the IRS TE/GE Council, and in number other health industry leadership roles. She also is an active member of the American Health Lawyers Association, the Health Care Finance Association, the Medical Group Management Association, the Health Care Compliance Association, the US-Mexico Chamber of Commerce Health Care Task Force, the US-Mexico Bar Association Health Care Committee and a host of other health industry, civic and professional organizations. Her insights on health care, health insurance, human resources and related matters have been quoted in The Wall Street Journal, Business Insurance, the Dallas Morning News, Managed Healthcare, Health Leaders, Aging Magazine, MDNews and a various other national and local publications.

A widely published author and highly sought-after speaker recognized for her ability to share complex ideas in practical, easy to understand and apply terms, Cindy is the author of hundreds of articles, training programs, and workshops. Cindy regularly conducts board, leadership, and compliance training for a broad range of health industry and other businesses, associations, and educational organizations. She is a standing columnist for MDNews Dallas. She also is a member of the editorial advisory boards of BNA's Employee Benefits Library on CD and various other highly regarded publications. She also regularly plans, presents training, and authors publications for the American Bar Association, Aspen Publishers, the American Health Lawyers Association, the Bureau of National Affairs, Spencer Publications, and a host of others. She has authored numerous useful and highly respected publications, training programs, and toolkits. For examples of some of these, see the Training & Presentations and Publications pages of this website.

Advice to and training for health care providers, Medicare Advantage plans, outsourcers and others about Medicare Advantage compliance, contracting, risk management, reimbursement and operations
Operations counsel on an on-demand basis for various health care systems and other health industry clients
Advise and assist clients with the design, formation and administration of health care and managed care entities and relationship including the formation of professional associations, for profit and non-profit health care related entities, integrated delivery systems, PHOs, MSOs, PPMs, 501(a) organizations, HMOs, PPOs, and other health care entities
Advise and representation on operational matters affecting health care and managed care entities
Cross border and international health care and insurance operations, staffing, compliance, contracting and other matters
Disaster preparedness and crisis response including real time crisis response counsel to hospitals and other health industry clients amid natural and other mass accident disasters, strikes, facility violence and other emergent operational situations
Managed care matters including managed care contracting, capitation, stop-loss and other reinsurance arrangements, utilization management, credentialing, claims administration procedures, and other related concerns
Advice to governmental and private health industry and other clients about legislative, regulatory, enforcement and other public policy matters relating to health care, employment, employee benefit, workers compensation, tax and other matters, Experience includes advocacy on behalf of health care providers and others for domestic and Mexican policy reforms to address Hispanic uninsured issues, acting as an advisor to the Government of Bolivia on the reform of its pension and social security system, and assistance to various trade associations regarding workforce, health care, workers compensation and other policy matters, as well as significant experience advising employers, health and managed care organizations, government officials and others in the United States and abroad about health care, social security, employment, and workforce, education, international, pension and other legislative and regulatory proposals and developments
Re-engineering of health care and insurance entities including workforce realignment or downsizing, corporate reorganization and restructuring, bylaw and credentialing design, process reengineering, compliance and internal control development and administration, and other related concerns
Design, administration, and defense of health care organization strategies, risk management systems and practices, and information systems to comply with applicable privacy, documentation, record retention, reimbursement, corporate compliance, and other legal and risk management concerns, including HIPAA, clean claims, and other applicable laws and regulations
Health care and insurance regulatory compliance
Exclusive provider and vendor contracting, credentialing, and other staff privileging matters; peer review, worker classification, HCQIA, fair hearing and due process, and other staffing and personnel matters
Documentation, negotiation and enforcement of exclusive provider contracts, employment contracts, independent contractor agreements, outsourcing, indemnification, confidentiality, insurance, administration agreements, hospital service agreements, HMO and PPO contracts, provider agreements, and other staffing and managed care agreements
Reimbursement, billing and collections, and claims payment and audit practices and procedures including reimbursement requirements under ERISA and other group health programs, individual insurance arrangements, Medicare, Medicaid, CHAMPUS, workers compensation and other programs and benefit coordination, subrogation and assignment matters
EMTALA, STARK, fraud and abuse, anti-referral, corporate practice of medicine, false claims, antitrust, OSHA, and other health care regulatory matters
DNR and other medical directives, privacy, and other patient rights matters
Consumer driven health care
Structuring, administration and defense of transactions and compliance strategies to minimize liability exposure under Stark, Fraud & Abuse, IRC Section 501(c)(3) and state non-profit statutes, federal and state antitrust, and other applicable laws
Prevention and defense of government investigations, litigation and other disputes related to health care, managed care, health care employee benefit plans, occupational injuries, and other tax, labor and insurance matters
Credentialing and peer review
Advises health industry and other employers, employee benefit plan sponsors, health care and managed care organizations, insurers, government officials, and others about program development, design, documentation, administration, communication, compliance, operation, risk management, defense, and legislative and regulatory reform and enforcement initiatives
Medicare, Medicaid, Texas Workers' Compensation Act and other federal and state law reimbursement matters
E-health and telemedicine matters
Interoperable health care matters
Design, administration, documentation, licensure, and defense of managed health, workers' compensation and disability programs, products, and services
Federal Sentencing Guideline and other compliance program, audits and practices; and
Other health care and insurance legislation, laws, regulations and matters