Christine Clements is a seasoned healthcare attorney who counsels clients on managed care regulatory issues and federal health care programs including the Medicare Advantage program, the Medicare Prescription Drug Benefit and Medicaid managed care. She is the regulatory lead of the firm’s Healthcare industry team.
Christine’s practice focuses on advising payers, providers and other entities on state and federal compliance issues as well as strategic transactions. She is known nationally for advising companies on the Medicare Advantage program with extensive experience representing companies on application denials and other disputes with the Centers for Medicare & Medicaid Services.
The former chief Medicare counsel at Aetna Inc., Christine was the lead attorney for the company's Medicare-related businesses, a background which enhances her ability to understand the issues most important to her clients.
With more than 30 years of experience advising on managed care law issues, Christine knows healthcare regulatory and business standards as few attorneys do. She advises on the full range of managed care issues, including:
- Contract applications and service area expansions
- Benefit design
- Responses to requests for proposals
- Employer/union group offerings
- Rate development and bidding
- Provider and vendor contracting and payment
- Medical loss ratio and other financial and reporting requirements
- Internal audits
- Risk adjustment
- Novations and contract consolidations
- Star Ratings
- Fraud and abuse, including safe harbors
- Sales and marketing strategies and compliance
- Compliance programs
- Government audits and investigations
- Administrative appeals
She also advises clients on state law requirements such as insurance and HMO licensure requirements, net worth and other financial requirements, market conduct and other audits, state mandates and extraterritoriality requirements.
In addition to advising on regulatory and operational issues, Christine advises healthcare clients in connection with mergers and acquisitions, strategic alliances and joint ventures, value-based contracting matters and other strategic planning issues.
Christine is managing partner of the Washington, D.C. office.