Lauren Haley brings a wealth of knowledge and perspective to guiding healthcare organizations through complex legal and regulatory requirements, with a deep appreciation of the underlying business objectives. In the field of healthcare law, she has provided legal analysis and advice, compliance guidance, health policy strategy, and government relations support.
Lauren has advised a variety of healthcare entities, including health plans, pharmacy benefit managers, pharmaceutical manufacturers, hospitals, home care providers, and copayment assistance foundations. She has also helped financial companies, such as private equity firms, evaluate regulatory risks associated with investing in healthcare entities.
Recognized as an authority on Medicare Advantage, Medicare Part D, and the Affordable Care Act, Lauren co-edited the Thomson Reuters treatise Regulation of Medicare Part D Plans with Strategic Health Law founder Elizabeth Lippincott.
Seeing the issues from all sides
Prior to joining Strategic Health Law, Lauren was Vice President, Pharmacy and Medicare Compliance Officer for MagellanRx Management, a prescription drug benefit management company, where she helped to launch a Medicare Part D plan. She joined Magellan when it acquired CDMI, LLC, where she was the Chief Legal and Compliance Officer. Working as in-house counsel, she was a key business partner to the leadership and operational teams.
Early in her career, Lauren gained significant experience in government regulations as a health insurance specialist in the Program Integrity Group at the Centers for Medicare & Medicaid Services (CMS). She helped develop regulations and guidance applicable to Medicare Part D plans, and co-authored the original Program to Control Fraud, Waste, and Abuse in the Medicare Prescription Drug Benefit Manual. Later, as an attorney at two large international law firms, she assisted health plans and service providers navigate the legal, regulatory, and sub-regulatory requirements applicable to Medicare Advantage, Medicare Part D, Medicaid Managed Care, and other third-party payment programs.
Safeguarding clients, one compliance matter at a time
Lauren works closely with clients to understand business objectives so she can provide practical advice in the context of legal and regulatory requirements. In addition to providing legal advice, Lauren helps clients resolve healthcare compliance issues. She assesses compliance programs and reviews written policies, assists in governmental and internal compliance audits, evaluates corrective action plans, and provides strategic advice in cases of self-disclosure. She also assesses proposed transactions and business relationships to ensure they are structured to comply with federal and state anti-kickback and self-referral statutes, and HIPAA and health information privacy.
Lauren is a member of the American Health Lawyers Association (AHLA).
Education and Honors
She received her B.A. from the University of Rochester and her J.D. from Seton Hall Law School, where she was the notes and comments editor for The Constitutional Law Journal, and served as the chair of the Women’s Law Forum. Upon graduation, Lauren received the National Association of Women Lawyers, Outstanding Woman Law Graduate Award.
Medicare Part D Direct and Indirect Remuneration- Where is it Headed?
Regulation of Medicare Part D
The Medicare Shared Savings Program: A Focus on Compliance
The Health Care Compliance Professional’s Manual
Beneficiary Assignment: For Whose Care is the ACO Responsible?
AHLA The ACO Handbook, A Guide to Accountable Care Organizations First Edition, © 2012
Medicare Secondary Payer Reporting: A New Relationship Between Medicare and Insurers
Practicing Law Institute’s Current Developments in Insurance Law 2010
It’s Risky Business: Medicare Risk Adjustment
HCCA Managed Care Conference
Lessons and Tools for Successfully Navigating Medicare Risk Adjustment
AHLA Institute for Health Plan Counsel
A Casual Conversation: The Window of Opportunity Opens for Success in 2018
Strategic Health Law
Critical Conversations: Strategies for Asks and Apologies
AHLA Women’s Leadership Initiative
Effectively Delegating Compliance Responsibilities
CBI’s Pharmacy Benefit Oversight and Compliance Congress
Medicare Advantage and Part D Plans: Getting Your House in Order
AHLA/Health Care Compliance Association’s Fraud and Compliance Forum
Risk Adjustment, RADV Audits, and Impact on Providers
AHLA Medicare and Medicaid Institute
CMS’s Draft Compliance Guidance for Medicare Advantage and Part D: What’s New, What’s Changing and What to Do About It
Medicare Shared Savings Program Final Rule: Where Do We Go from Here
Webcast Series Providing Accountable Care: Strategy & Structure
Beneficiary Assignment and Marketing Requirements in the Medicare Shared Savings Final Rule
AHLA webcast series, An Overview of the ACO Proposed Regulations; Part I: Eligibility Requirements, Patient Attribution, and Participating in Medicare's Shared Savings Program
Marketing Compliance and CMS Enforcement – Achieving Best Possible Results within CMS Guidelines
7th Annual World Congress Leadership Summit on Medicare
Hot Topics in Health Reform: Spotlight on Accountable Care Organizations
D.C. Bar, Healthcare Section
So you Want to Partner with CMS … Practical Considerations for Medicare ACOs
Webcast series, Providing Accountable Care: Strategy &Structure