Kathryn’s practice is at the intersection of three industry groups: health care, insurance, and government contracts. For three decades she has represented health care insurers and affiliates in their work with federal health care programs (including Medicare, Medicaid, the Federal Employees Health Benefits Program, Veterans Health Administration, and TRICARE). From government contractors of administrative services to managed care organizations with underwriting risks, all must navigate complex regulations and government oversight. Kathryn has devoted a significant part of her practice to representing these clients in procurement matters, litigation, and regulatory disputes; defending contractors in False Claims Act investigations and qui tam suits; and negotiating complex pharmacy benefit management (PBM) contracts. Kathy advises contractors on procurement matters related to the federal government’s response to COVID-19.
Kathryn is co-chair of the firm’s Health Care Group and also chair and founder of the firm’s specialty practice for property and casualty (P&C) insurers with statutory and regulatory obligations under Medicare and Medicaid. Her unique practice mix has positioned her as a recognized thought leader on Medicare secondary payer issues for these insurers, including how to meet their “Section 111” reporting and reimbursement obligations. Read more here.
- For insurers:
- Counsels on health care policy, legislation, and regulatory matters.
- Advises on the application of federal health care law to the businesses of P&C insurers and specialty lines.
- Counsels and writes frequently on a wide range of Medicare secondary payer (MSP) issues:
- Obligations of “group health plans” and “non-group health plans” (also known as “NGHPs,” which include liability, no-fault, and workers’ compensation carriers) to reimburse Medicare for “conditional payments;”
- Voluntary Medicare set-aside (MSA) arrangements and other structured settlements;
- MSP claims audits;
- Internal legal reviews and related voluntary self-disclosures and remediation plans;
- Mistaken payments and the working aged rule;
- MSP statute of limitations;
- Mandatory reporting obligations of P&C insurers (or non-group health plans) under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA); Section 111 penalties; and
- Classification of professional liability and accident & health insurance under Section 111.
- Often cited articles include:
- "Setting the Record Straight: Dispelling Medicare Myths in Tort Settlements", DRI's for the Defense (May 2013).
- "Broad Application of Medicare’s Mandatory Insurer Reporting Requirements to Non-U.S. Property & Casualty Carriers Flouts Supreme Court Limitations on Extraterritorial Reach of U.S. Law", Insurance Coverage Law Report (July 2014).
- Wiley's Section 111 Bulletins (2009 to present).
- Defends health care and P&C insurers in administrative proceedings and related appeals challenging MSP reimbursement demands.
- Defends insurers in MSP False Claims Act litigation.
- Audits MSP compliance programs for P&C insurers and works hand-in-hand with their Medicare compliance vendors.
- Advises on Medicare Advantage (MA) and Medicare Part D program compliance and associated contract administration matters for MA organizations (MAOs) and Prescription Drug Plans (PDPs).
- For health care government contractors:
- Counsels on health care policy, legislation, and regulatory matters, including those arising under the Affordable Care Act.
- As lead counsel, routinely defends cases brought by Medicare providers and suppliers against Medicare contractors in federal court; all have ended in dismissal.
- Defends government contractors in investigations, suits, and third-party actions under the False Claims Act, having achieved government declination or resolution prior to intervention in more than a dozen cases.
- Litigates bid protests before the U.S. Government Accountability Office (GAO) and the Court of Federal Claims, including the successful defense of the first Medicare Administrative Contractor (MAC) award in DME Jurisdiction D in 2006 and subsequent Cycle Two MAC protests.
- Successfully arbitrated a state health insurance exchange/IT dispute between prime and subcontractor resulting in a $11 million award, defeating related claims in federal district court and resolving an umbrella state/prime contract performance dispute.
- Advises on cybersecurity and data rights and privacy issues for Medicare contractors.
- Counsels on compliance with the Anti-Kickback laws and the Federal Acquisition Regulation (FAR) Mandatory Disclosure Rule.
- Defends cost audits before federal agencies and litigates final audit decisions before Boards of Contract Appeals.
- Prepares contracts, subcontracts, affiliate agreements, contractor certifications, and administrative claims.
- Advises Medicare contractors on contractor performance issues, suspension and debarment matters, and contractor reporting obligations.
- Assesses cost allowability and allocability issues under the FAR.
- For a broad array of commercial entities:
- Leads internal investigations for compliance officers and general counsel.
- Negotiates PBM contracts (retail, mail order, and specialty drugs) and counsels on related pharmacy benefit issues, including rebate contracting. Read more here.
- Conducts health care due diligence for mergers and acquisitions.
- Implements and reviews corporate compliance programs.
- American Bar Association (ABA)
- Vice-Chair (2004-2005) and Member, Accounting, Cost & Pricing Committee, Section of Public Contract Law
- Procurement Fraud and Health Care Contracting Committees, Section of Public Contract Law
- Section of Health Law
- American Health Lawyers Association (AHLA)
- America’s Health Insurance Plans (AHIP)
- Board of Trustees, The Barker Adoption Foundation
- Received 2013 Burton Award for Distinguished Legal Writing for "Supreme Court Affirms Opportunities and Uncertainties for Health Care Contractors"
- Received 2016 Richard B. Barker Award for leadership and service contributions to The Barker Adoption Foundation
- Wiley Pro Bono Champion (2014, 2016, 2017, and 2019)
- Past Member, Firm Management Committee and Vice-Chair, Pro Bono Committee
J.D., Cornell Law School
B.A., cum laude, University of Vermont
Senior Editor, Cornell International Law Journal
Bar and Court Memberships
- District of Columbia Bar
- Supreme Court of the United States
- U.S. Court of Appeals for the Ninth Circuit
- U.S. Court of Federal Claims
- U.S. District Courts for the District of Columbia and District of Maryland
Related News & Insights
- Press ReleaseWiley Recognizes More Than 40 Individuals in Eighth Annual Pro Bono Program CelebrationNovember 3, 2020
- Press ReleaseWiley Launches Coronavirus Task Force to Help Clients With Emerging IssuesMarch 26, 2020
- Press ReleaseWiley Helps Adoption Agency File Comments Opposing Federal Rule Allowing Discrimination In Adoption And Foster ServicesJanuary 30, 2020
- Press ReleaseWiley Rein Recognizes 19 Individuals in Seventh Annual Pro Bono Program CelebrationOctober 29, 2019