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Cynthia Marcotte Stamer is nationally and internationally recognized for her experience with managed care, accident and health, life, and other insurance and risk management matters. Cindy’s clients include insurers, HMOs, PPOs, businesses, managing general underwriters (MGUs), third party administrative services providers (TPAs), claims administrators, adjusters, medical bill reviewers, government and non-governmental employer insured and self-insured employee benefit plans, their sponsors and fiduciaries, risk managers, utilization review organizations, insurance and benefit industry outsourcers and others.
Known for her high accessibility and ability to respond to triage crisis and other emergent legal and business concerns, Cindy has more than 20 years experience acting as outside operations and special counsel. As a continuous focus of this practice, she helps these and other industry clients, manage legal risks and compliance, improve operational effectiveness, investigate concerns, and defend or resolve legal or other challenges through her legal practice, leadership in professional and civic organizations, writings and publications, and policy advocacy.
Clients value Cindy for her ability to provide real time, pragmatic guidance in response to emergent situations, her talent for assisting clients with the complex details involved in the development and implementation of new insurance or benefit products or programs, systems, processes, and other risk management, compliance or business initiatives and her ability to assess and defend disputes and other controversies arising from the administration or operation of these arrangements. Cindy applies her substantial legal and operational experience and in-depth knowledge of insurance, employee benefits, corporate compliance, human resources, privacy and data security, tax and other related matters to assist clients to formulate innovative products and pragmatic insurance and risk management strategies taking into account the financial, operational, political, legal and other realities confronting the client.
Throughout her career, Cindy has worked on the design, development, administration, and defense of health and managed care, occupational injury and worker’s compensation, accident, disability, life, individual and group insurance and employee benefit arrangements. Her experience includes providing cutting edge advice to insurers and businesses about the design of mini-med and other innovative consumer driven health care products, nonsubscriber and other worker’s compensation and occupational risks management and insurance strategies, health and other benefit programs for expatriates, medical tourism, managed care and other tailored arrangements, as well as a wide range of other matters.
Cindy’s resume includes significant experience working with clients on a diverse range of product development, operations, regulatory, licensure, compliance, claims investigation and defense, public policy and other matters. Industry clients, government leaders and others often seek out Cindy as a knowledgeable leader, problem-solver and innovator on health and other insurance concerns. She has provided insight and representation to health insurers, third party administrators, self-insured employer and union sponsored health and welfare plans and their fiduciaries, PPOs, EPOs, HMOs, 501A organizations, outsourcers, legislators and other public policy leaders and others to design and innovate, document, administer, interpret, and defend a diverse range of health and other group and individual benefit programs and products. Her work encompasses a lengthy resume of experiences dealing with the full array of U.S. private and public health payment systems, including insured and self-insured health and managed care; health flexible spending accounts (health FSA); health savings accounts (HSA); prescription drugs; wellness and disease management; health reimbursement accounts (HRA); catastrophic heath plans; limited benefit; high deductible reimbursement; expatriate and other private health and welfare benefit policies, programs, plans, and arrangements as well as Medicare Advantage and certain other governmental managed care programs. Cindy’s resume includes significant experience working with the insurance industry and clients on a diverse range of product development, operations, regulatory, licensure, compliance, claims processing and investigation, data security and privacy, workforce and process reengineering, cost containment, claims processing, public policy, risk management, defense of audits, and other matters. Cindy also regularly advises, represents, defends and trains insurers, risk managers, businesses, boards of directors, fiduciaries, insured and self-insured health plan sponsors and others about legal risks and legal, insurance and other risk management strategies and practices that reduce and resolve a wide range of legal and operational exposures.
Cindy also has extensive experience helping insurers, brokers, underwriters, administrators and adjusters, risk managers, reinsurers, governmental entities, private employers, employee benefit plans and others design, document, administer, and defend their insurance products and operations. She works extensively with insurance, health care, and other businesses, governments and others to manage their people and processes to achieve their business and operational objectives and manage legal and other risks. Her experience includes advising clients, investigating, conducting training and other activities to prevent, investigate, and redress broker and other licensed party misconduct under insurance, procurement, ERISA, and other laws, regulations, and Codes of Ethics.
Cindy regularly advises clients about compliance with ERISA, COBRA, HIPAA, Medicare Secondary Payor, Medicare Part D, Medicare Advantage, Medicaid, LMRA, NLRA, the Internal Revenue Code, state prompt pay, clean claims, licensure, deceptive trade practices, market reform, contracting, ethics and compliance and other applicable federal and state laws and regulations. She also advises and represents clients in connection with investigations, litigation, audits, and other actions involving the Department of Labor, IRS, Federal Trade Commission, CMS, HHS, Office of Civil Rights, Office of Inspector General, state department of insurance, state attorney general, boards of medicine, and other federal and state regulators. Cindy’s experience also extends to the design, documentation, administration and defense of a wide range of employer and other group life pension and annuity, group legal services, identity theft, accident, and other personal protection plans, policies and practices as well as other insurance and risk management products and processes. Her experience also includes advice and representation of a broad range of state and local governmental entities, their employee benefit and insurance programs, vendors, and others about procurement, compliance, administration, risk management, disputes, and other related matters.
Her managed care and insurance work includes both the review, design, documentation and enforcement of the plans, polices and programs themselves, as well as the drafting, review, negotiation and enforcement of third party administration and other outsourcing, stop loss and other reinsurance, preferred provider organization, provider contracts, and other related arrangements. She drafts and reviews certificates of insurance, summary plan descriptions, notices, marketing, explanations of benefits, privacy practices and other communications, and administration and compliance policies and procedures. She assists health insurers, third party administrators, medical bill review, utilization management, online and other payroll and eligibility administrators and systems providers and others to design processes and procedures to administer programs and operations in accordance with applicable regulatory and contractual mandates, maintain privacy and data security, improve operations, improve defensibility, and minimize liabilities.
The author of the Health Plan Eligibility Toolkit, Cindy has assisted in the development and administration of a wide range of eligibility and enrollment processes and systems, including internet and intranet based electronic eligibility administration and enrollment systems and technologies, communications, and processes. Cindy has extensive experience advising insurers, TPAs, self-insured plan fiduciaries and sponsors, medical bill reviewers, and others about ERISA, prompt pay, and other claims investigation and administration, licensure, regulatory, public policy, operations and compliance, tax, and other operational matters. She also has experience designing and defending programs for associations, fraternal benefit societies, multiple employer welfare arrangements, state and local governments, churches, and other non-ERISA regulated groups.
Cindy also is experienced with a diverse array of other insurance and risk products, services and matters. She has experience drafting, reviewing, and negotiating property; casualty; trade credit and letters of trade credit; travel; shipping and other transportation; bonds and security; stop-loss and reinsurance; subrogation, assignment indemnification subcontractor and other risk shifting agreements; liability, disaster, and risk assessment, prevention, mitigation, recovery and response strategies and other risk management programs; compliance plans; errors and omissions (E&O); malpractice and other liability; employment practices liability (EPL); fiduciary liability and other management liability policies and coverage; terrorism business interruption, and cybercrime and other crisis management coverage; and other insurance and risk management products, processes, services, protocols and agreements.
She has extensive experience training and advising insurers, brokers, underwriters, administrators and adjusters, reinsurers, employee benefit plans and others to design, document, administer, and defend their insurance products and operations. She also has worked extensively with insurance, health care, and other businesses, governments and others to manage their people and processes to achieve their business and operational objectives and manage legal and other risks. She also assists insurance industry clients on a wide range of risk management, compliance, internal controls, market integrity, and other compliance and risk management programs. She provides advice, drafts policies, and procedures, conducts compliance and risk management audits and training, and represents industry clients in dealings with vendors, regulators, customers and others.
AV-rated and recognized by International Who’s Who of Professionals, Cindy also is widely recognized for her industry leadership and involvement in a broad range of professional and civic organizations, her speaking and training on industry concerns, and her highly respected publications and other writings on these and other matters. A member of the leadership council of the American Bar Association (ABA) Joint Committee on Employee Benefits, the Immediate Past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, Vice Chair of the ABA Real, Property Probate and Trust Section Employee Benefits and Compensation Committee and Vice Chair of the ABA Tort & Insurance Practices Workers’ Compensation Committee, Cindy also regularly conducts training, writes, and participates in a wide range of other industry organizations and activities.
Cindy also is the author of hundreds of highly regarded works and training programs on managed care and insurance, employee benefits, tax, and other risk management and compliance matters. She also is a popular speaker who regularly conducts training for a host of clients and conferences. 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. Her highly regarded publications regularly appear in the American Bar Association, Aspen Publishers, the American Health Lawyers Association, the Bureau of National Affairs, and a host of other publications. 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 and various other national and local publications.
Ms. Stamer is board certified in labor and a graduate of Arizona State University and Loyola Law School in Los Angeles. She and her husband, Doug, are the proud parents of two boys, Max, age 13, and Luke, age 8. In her spare time, she enjoys sports, travel, cooking and entertaining, and gardening.
|Selected publications and presentations of Ms. Stamer are available at:|