Christine M. Clements

Christine Clements is a partner in the Governmental Practice and the Managing Partner of the firm’s Washington, D.C. office. She is also a Deputy Team Leader of the firm’s Healthcare Team.

Areas of Practice

With more 30 years of experience in managed care law issues, Christine's practice includes federal healthcare government contract programs such as the Medicare Advantage Program, the Medicare Prescription Drug Benefit, the Federal Employees Health Benefits Program and Medicaid managed care. She advises health plan clients on the issues most important to them, including contract applications and service area expansions; responses to requests for proposals; rate development and bidding; medical loss ratio and other financial and reporting requirements; risk adjustment; Star Ratings; sales and marketing strategies and compliance; benefit design; employer/union group offerings; provider and vendor contracting and payment; internal audits; novations and contract consolidations; fraud and abuse, including the discount and managed care safe harbors; and compliance programs.

Christine advises clients undergoing government audits and investigations. She also represents clients in administrative appeals including appeals of Centers of Medicare and Medicaid Services application denials, assessments of civil money penalties, intermediate sanctions and Star rating/quality bonus payment determinations.

In addition, Christine advises clients on state law requirements such as insurance and HMO licensure requirement, net worth and other financial requirements, market conduct and other audits, state mandates and extraterritoriality requirements.

Further, Christine advises healthcare providers and suppliers including accountable care organizations and pharmacies, as well as intermediaries such as management service organizations. She also advises healthcare industry clients in connection with mergers and acquisitions, strategic alliances and joint ventures, value-based contracting matters, and other strategic planning issues.

Previously, Christine served as Chief Medicare Counsel at Aetna Inc., where she was responsible for the company's Consumer Segment. In this role, she was the lead attorney for the company's Medicare Advantage and Medicare Prescription Drug Benefit businesses, Medicare Supplement products and other retiree plans.

Christine has written and presented on the Medicare Advantage and Medicare Prescription Drug Benefit programs, the Federal Employees Health Benefits Program, Star Rating issues, value-based contracting arrangements and the HIPAA Privacy Rule, among other topics.

Honors

Recommended Lawyer - Healthcare, Legal 500 US, 2019-2021, 2023-2024

Articles

Healthcare Law Blog Posts

• "CMS Releases First Annual Evaluation Report for Kidney Care Choices Model," September 30, 2024

• "No Surprises Here – Providers Win Again in No Surprises Act TMA II Litigation Vacating Independent Dispute Resolution Rule," August 7, 2024

• "Texas Court Stays CMS CY2025 Final Rule on Agent and Broker Compensation and Contract Term Restrictions," July 5, 2024

• "CMS Issues CY2025 Medicare Advantage and Part D Final Rule," April 15, 2024

• "Comment Period for the No Surprises Act Proposed Rule, 'Federal Independent Dispute Resolution (IDR) Operations,' Will Reopen," January 19, 2024
• "CMS Promotes Competition, Transparency, Health Equity and More in the CY2025 Medicare Advantage and Part D Proposed Rule," November 13, 2023
• "Medicare Advantage RADV Audit Final Rule Challenged in Court," September 28, 2023
• "Sheppard Mullin Webinar – No Surprises Act: Litigation Update and Recent Guidance," September 6, 2023
• "CMS Releases First Set of Part B Rebatable Drugs for Coinsurance Adjustment Under IRA," March 15, 2023

• "CMS Releases Guidance on Implementation of Rebate Programs for Certain Medicare Part B and Part D Drugs," February 22, 2023
• "CMS Issues Long-Awaited Medicare Advantage RADV Final Rule," February 1, 2023
• "CMS Augments “In Lieu Of Services” Medicaid Guidance to Support State Medicaid Managed Care Efforts to Address Social Determinants of Health," January 20, 2023
• "Key Healthcare Provisions of the Consolidated Appropriations Act, 2023," January 6, 2023
• "CMS Issues CY2024 Proposed Rule for Medicare Advantage Organizations and Part D Sponsors," January 5, 2023
• "CMS Proposes to Amend Overpayment Rule, Remove Potential Overpayment and False Claims Act Liability for Mere Negligence," December 27, 2022
• "CMS Includes MAOs in Data Exchange and Prior Authorization Requirements," December 15, 2022
• "Senate Committee Issues Report On Deceptive Marketing Practices in Medicare Programs," November 4, 2022
• "CMS Pushes Publication of Final FFS Adjuster for RADV Audits Rule to February 1, 2023," November 1, 2022
• "CMS Heightens Oversight of TPMO Marketing Programs, Restricts TV Advertisements," October 31, 2022
• "Healthcare Reforms Under the IRA: Expanding Access to Care," August 25, 2022
• "Putting the Brakes on Healthcare M&A and Provider/Payor Contracting: AB 2080 Poised to Dramatically Impact Healthcare Transactions in California," July 7, 2022
• "CMS Issues Contract Year 2023 Final Rule for Medicare Advantage Organizations and Prescription Drug Sponsors," May 16, 2022
• "HHS OIG Signs Off on Substance Use Recovery Incentive Program," March 24, 2022
• "'REACHing' For Health Equity: CMS Revamps The Global And Professional Direct Contracting Model," March 2, 2022
• "CMS’s Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs," January 10, 2022
• "D.C. Circuit Gives New Life to CMS Overpayment Rule," August 17, 2021

• "Federal Court Decides ACA “Sabotage” Case," March 12, 2021

• "New Guidance on Health Plans’ COVID-19 Coverage Obligations," March 2, 2021

• "Trump Administration Finalizes The Transparency in Coverage Rule," November 12, 2020

• "CMS Issues the 2022 Medicare Advantage Advance Notice Part I – Risk Adjustment," September 24, 2020

• "HHS OIG Issues Report Critical of Medicare Advantage Risk Adjustment Practices," September 24, 2020

• "Supreme Court Issues Long Awaited Ruling on Affordable Care Act Risk Corridors Program," April 27, 2020

• "CMS Issues Guidance on Risk Adjustment and Telehealth Services," April 10, 2020

• "Key Health Care Provisions of the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”)," March 30, 2020
• "Families First Coronavirus Response Act Imposes Benefit Mandates on Insurers and Group Health Plans," March 19, 2020

• "Medicare Advantage Plans, Medicare Prescription Drug Plans and FEHBP Carriers Take Note: CMS and OPM Announce Actions to Address the Threat of Coronavirus," March 12, 2020

• "Top 10 Provisions of CMS Proposed Rule: Medicare Advantage and Part D Programs for CY2021 and CY2022," February 13, 2020 
• "CMS Proposes Changes to the Medicare Advantage and Part D Programs for CY 2021 and 2022," February 6, 2020 
• "Why the Health Care Industry Should Be Concerned About Section 889 of the 2019 National Defense Authorization Act," February 3, 2020
• "Congress Continues to Focus on Prescription Drug Pricing," December 27, 2019 
• "CMS Plans Updates to Star Ratings," August 29, 2019 
• "Is Prescription Drug Pricing The Cure For Partisanship?" July 25, 2019 
• "SCOTUS Rejects CMS DSH Policy, Calls CMS Guidance Practices Into Question," June 6, 2019 
• "Arkansas and Kentucky Halt Medicaid Work Requirements," April 26, 2019 
• "OCR Seeks Ideas on HIPAA Rule Changes to Promote Value-Based Care and Coordinated Care," December 14, 2018 
• "CMS Issues Proposed Rule on Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses," November 28, 2018
• "Blog Series: CMS Proposed Rule on Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021," October 29, 2018
• "How Broad is the Managed Care Safe Harbor?," October 26, 2018 
• "CMS’ Medicare Advantage Overpayment Rule: Arbitrary, Capricious, and Vacated," September 7, 2018 
• "CMS Proposes Massive Changes to ACO Program – Pushing Providers to Accept Downside Risk," August 16, 2018 

Media Mentions

Speaking Engagements

• Speaker, "Understanding the Legal Landscape: Regulatory Compliance," 2024 WHLC Women in Healthcare Leadership Summit, October 24, 2024
• Presenter, "Policy Update #2: The Latest Activity in Washington, D.C. and Why It Matters," Health Plan Alliance, May 29, 2020
• Presenter, "MA and PDP CY2021 – 2022 Proposed Rule," Health Plan Alliance 2020 Fly in: Medicare Advantage Product Design and Implementation, February 10-11, 2020
• Presenter, "Federal And State Regulatory Updates Impacting Drug Pricing And Pharmacy Benefit Management Programs," Health Plan Alliance Pharmacy Summit, May 29-30, 2019
• Presenter, "CMS’ Medicare Advantage Overpayment Rule Takes a Permanent Vacation: What’s Next for Payors and Providers Alike," Sheppard Mullin Healthcare Webinar, October 16, 2018
• Presenter, "Medicare Part C and Part D Quality Star Ratings: What Plan Lawyers Should Know and Care About," Blue Cross Blue Shield National Summit, Orlando, Florida, May 1-4, 2018

Events

Memberships

Member, American Bar Association

Member, American Health Lawyers Association

Digital Media