HELAINE I. FINGOLD is a Partner in the Health Care and Life Sciences practice in the Baltimore office of Epstein Becker Green. She has more than 32 years of broad health law and health regulatory experience, including 20 years in the federal legislative and executive branches.   

Ms. Fingold advises health care plans and issuers, providers, and other stakeholders on legal and policy issues regarding the Medicare Advantage and Part D programs, including, but not limited to: A/B and supplemental benefits: appeals and grievances; general program compliance; marketing, agent/broker and TPMO issues; star ratings/quality bonus payments; program/financial audits and other program oversight; bid requirements and review; Medical Loss Ratio; and program enforcement/sanctions and appeals.  She also advises on Medicare A and B, Medicaid fee-for-service and waiver/managed care programs, Medicare and Medicaid innovation programs, Qualified Health Plans and ACA commercial plan requirements, and federal and state Surprise Billing rules.    

From 2004 to 2012, Ms. Fingold worked in a range of capacities at the Centers for Medicare & Medicaid Services (CMS), with responsibility for areas of the Medicare Advantage program, including plan application review and approval, network adequacy, application denials and appeals, contracting, plan surveillance and oversight, and Medicare Advantage and Part D marketing. Subsequently, Ms. Fingold served in both senior staff and leadership roles with the Center for Consumer Information and Insurance Oversight (CCIIO) in the Exchange Policy and Operations Group through which Ms. Fingold worked on the qualification of qualified health and stand-alone dental, plan oversight, essential health benefits, agent/broker issues, and market-wide cost-sharing limitations.   

Ms. Fingold began her professional career as an attorney with the Department of Health and Human Services (HHS), and then as a team lead within the Office of Research and Demonstrations at CMS’s predecessor agency, working on Medicaid waiver and Medicare demonstration programs. She then spent two years as a health care attorney with the DC office of Epstein Becker Green. She left the firm to serve as General Counsel for the Medicare Payment Advisory Commission.