Areas of Practice

Attorney Cynthia Marcotte Stamer is nationally and internationally recognized for her experience with managed care and other accident & health, life, and other insurance and risk management matters. Cindy’s clients include insurers, HMOs, PPOs, businesses, managing general underwriters (MGUs), third party administrative services providers (TPAs), claims administrators, adjusters, medical bill reviewers, insured and self-insured employee benefit plans, their sponsors and fiduciaries, risk managers and others about a diverse array of insurance and risk management concerns.

When working with clients, Cindy applies her substantial legal and operational experience about insurance, employee benefits, corporate compliance, human resources, privacy and data security, tax and other related matters to assist clients to formulate innovative products and pragmatic insurance and risk management strategies taking into account the financial, operational, political, and legal and other realities confronting the client. Clients value Cindy both for her ability to provide real time, pragmatic guidance in response to emergent situations, as well as her talent for assisting clients with the complex details involved in the development and implementation of new insurance or benefit products or programs, systems, process, and other risk management, compliance or business initiatives.

Cindy has extensive experience helping insurers, brokers, underwriters, administrators and adjusters, risk managers, reinsurers, business employee benefit plans and others design, document, administer, and defend their insurance products and operations. She also works extensively with insurance, health care, and other businesses, governments and others to manage their people and processes to achieve their business and operational objectives and manage legal and other risks. When working with clients, Cindy applies her in-depth knowledge of insurance, employee benefits, corporate compliance and other legal matters to assist clients to formulate pragmatic insurance and risk management strategies taking into account the financial, operational, political, legal and other realities confronting the client.

Cindy’s resume includes significant experience working with insurance industry and clients on a diverse range of product development, operations, regulatory, licensure, compliance, claims processing and investigation, data security and privacy, workforce and process reengineering, cost containment, claims processing, public policy, risk management, defense of audits, and other matters. Cindy also regularly advises, represents, defends and trains insurers, risk managers businesses, boards of directors, fiduciaries, insured and self-insured health plan sponsors and others about legal risks and using legal, insurance and other risk management strategies and practices to reduce and resolve a wide range of legal and operational exposures.

Chair of both the American Bar Association (ABA) Health Law Section Managed Care & Insurance Interest Group and the ABA Real, Property Probate and Trust Section Welfare Plan Committee and Vice Chair of the ABA Tort & Insurance Practices Workers’ Compensation Committee, Cindy is nationally and internationally recognized for her experience with health and managed care, occupational injury and worker’s compensation, accident, disability, life, and other individual and group benefits programs. Her resume includes significant experience working with clients on a diverse range of product development, operations, regulatory, licensure, compliance, claims investigation and defense, public policy and other matters

Clients, government leaders and others often seek out Cindy as a leader and innovator on managed care and health coverage matters. For nearly 20 years, Cindy has provided insight and representation to health insurers, third party administrators, self-insured employer and union sponsored health and welfare plans and their fiduciaries, PPOs, EPOs, HMOs, 501A organizations, outsourcers, legislators and other public policy leaders and others to design and innovate, document, administer, interpret, and defend a diverse range of health and other group and individual benefit programs and products. Her work encompasses a lengthy resume of experience dealing with the fully array of U.S. private and public health payment systems, including insured and self-insured health and managed care; health flexible spending account (health FSA); health savings account (HSA); prescription drug; wellness and disease management; health reimbursement account (HRA); catastrophic heath plans; limited benefit; high deductible reimbursement; expatriate and other private health and welfare benefit policies, programs, plans, and arrangements as well as Medicare Advantage and certain other governmental managed care programs.

Cindy regularly advises clients about compliance with ERISA, COBRA, HIPAA, Medicare Secondary Payor, Medicare Part D, Medicare Advantage, Medicaid, LMRA, NLRA, the Internal Revenue Code, state prompt pay, clean claims, licensure, deceptive trade practices, market reform, and other applicable federal and state laws and regulations. She also advises and represents clients in connection with investigations, litigation, audits, and other actions involving the Department of Labor, IRS, Federal Trade Commission, CMS, HHS, Office of Civil Rights, Office of Inspector General, state department of insurance, state attorney general, boards of medicine, and other federal and state regulators. Cindy’s experience also extends to the design, documentation, administration and defense of a wide range of other employer and other group life; pension and annuity, group legal services, identity theft, accident, and other personal protection plans, policies and practices as well as other insurance and risk management products and processes.

Her managed care and insurance work includes both the review, design, documentation and enforcement of the plans, polices and programs themselves, as well as the drafting, review, negotiation and enforcement of third party administration and other outsourcing, stop loss and other reinsurance, preferred provider organization, provider contracts, and other related arrangements. She drafts and reviews certificates of insurance, summary plan descriptions, notices, marketing, explanations of benefits, privacy practices and other communications, and administration and compliance policies and procedures. She assists health insurers, third party administrators, medical bill review, utilization management, online and other payroll and eligibility administrators and systems providers and others to design processes and procedures to administer programs and operations in accordance with applicable regulatory and contractual mandates, maintain privacy and data security, improve operations, improve defensibility, and minimize liabilities. The author of the Health Plan Eligibility Toolkit, Cindy has assisted in the development and administration of a wide range of eligibility and enrollment processes and systems, including internet and intranet based electronic eligibility administration and enrollment systems and technologies, communications, and processes. Cindy has extensive experience advising insurers, (TPAs), self-insured plan fiduciaries and sponsors, medical bill reviewers, and others about ERISA, prompt pay, and other claims investigation and administration, licensure, regulatory, public policy, operations and compliance, tax, and other operational matters. She also has experience designing and defending programs for associations, fraternal benefit societies, multiple employer welfare arrangements, state and local governments, churches, and other non-ERISA regulated groups.

Cindy also is experienced with a diverse array of other insurance and risk products, services and matters. She has experience drafting, reviewing, and negotiating property; casualty; trade credit and letters of trade credit; travel; shipping and other transportation; bonds and security; stop-loss and reinsurance; subrogation, assignment indemnification subcontractor and other risk shifting agreements; liability, disaster, and risk assessment, prevention, mitigation, recovery and response strategies and other risk management programs; compliance plans; errors and omissions (E&O); malpractice and other liability; employment practices liability (EPL); fiduciary liability and other management liability policies and coverages; terrorism business interruption, and cybercrime and other crisis management coverages; and other insurance and risk management products, processes, services, protocols and agreements.

She has extensive experience helping insurers, brokers, underwriters, administrators and adjusters, reinsurers, employee benefit plans and others design, document, administer, and defend their insurance products and operations. She also works extensively with insurance, health care, and other businesses, governments and others to manage their people and processes to achieve their business and operational objectives and manage legal and other risks. She also assists insurance industry clients on a wide range of risk management, compliance, internal controls, market integrity, and other compliance and risk management programs. She provides advice, drafts policies, and procedures, conducts compliance and risk management audits and training, and represents industry clients in dealings with vendors, regulators, customers and others.

AV-rated and recognized by International Who’s Who of Professionals, Cindy also is the author of hundreds of highly regarded works and training programs on managed care and insurance, employee benefits, tax, and other risk management and compliance matters. She also is a popular speaker who regularly conducts training for a host of clients and conferences.

Example of some common client engagements include:

Advise and represent insurance and financial services industry clients about state licensure, regulation, legislation and enforcement including ERISA and other federal law preemption, substantial minimum contacts and other defenses to foreign state long arm jurisdiction, and related matters

Advise and represent insurance, financial services, and employee benefit clients about federal regulatory, enforcement and public policy matters

Counsel and assist client with product and program design and implementation of insured and self-insured employer and union health and other welfare plans, MEWAs, group insurance, fraternal benefit, association, purchasing group, worker’s compensation and occupational injury, cafeteria plan, HSAs, pension and profit sharing, executive compensation, ex-patriate benefit arrangements, and other insured and self-insured health, life, accident, disability, annuity, long-term care, prescription drug, Medicare Advantage and Medicare Supplement, identity theft and other policies, products, programs and practices

Draft, review, revise and interpret insurance policies, third party administration, subcontractor and outsourcing, fiduciary appointment, delegation, MGU and other marketing agreements, indemnification and related agreements

Assistance with establishment and formation of insurance entities, employee benefit plans, employment, marketing and distribution, contracting, risk management, product design and licensure, and other operational matters

Advise and represent insurers, ERISA-covered health plans and their fiduciaries, brokers, third party administrators, MEWAs, technology providers and insurance and employee benefit plan about Federal Sentencing Guideline and other compliance including IRC, ERISA, COBRA, USERRA, SCAR, WARN, ADA and other disability discrimination laws, FMLA, Title VII, Fair Labor Standards Act, whistleblower, privacy, NLRA, HIPAA, FACTA, Patriot Act, Gramm-Leech, tax reporting and withholding, UBIT and excise tax, unemployment compensation, federal and state securities, banking, insurance, and government contracting, market integrity, false claims, deceptive trade practices, antitrust, broker compensation, prompt pay, EDI, Medicare, Medicaid, Social Security Act, procurement, and other federal and state regulatory compliance and enforcement matters

Advise and counsel clients regarding the development and use of electronic and other eligibility and enrollment, participant and subscriber communications, claims processing, claims payment, medical bill review, utilization management, broker relationship management, and related operations systems

Advise insurance industry clients about design, administration and defense of claims investigation, medical bill audit, utilization management, fraud prevention and investigation, and administration and payment practices and other risk management procedures

Conduct compliance audits and risk assessments

Advise and assist insurers, fiduciaries, plan sponsors, administrators, service providers, companies, boards, executives and others about design and administration of corporate compliance and risk management strategies to manage and mitigate federal and state regulators and operational risks

Advise about subrogation and coordination of benefits and coverage including group and individual coverages, Medicare, Medicare Advantage, Medicare Advantage, Tricare, Medicaid, CHIP, worker’s compensation, no-fault and other coverages

Draft, review and advise clients about managed care and insurance industry contracting matters including administrative services agreements, group insurance contracts, outsourcing and other delegation contracts, provider and other managed care contracts, data security agreements, business associate agreements, licensing agreements, and others

Analysis, advice, and advocacy of clients concerning proposed legislation and regulations and representation before legislators, regulators, and other government officials and agencies

Defense of investigations, audits, and enforcement actions by Department of Labor, Internal Revenue Service, Health and Human Services, Office of Civil Rights, attorneys general, FTC, state insurance and other regulators, and other Federal and state agencies

Counsel and defend insurers, third party administrators (TPAs), employers, ERISA fiduciaries and service providers and others against insurance, employee benefit, employment and other lawsuits and enforcement actions by private plaintiffs

Counsel and assist clients with development, documentation and administration of compliance, administration, fraud investigation, internal control, technologies, and other systems and processes

Provide training for insurance companies, brokers, employee benefit plans and their fiduciaries, plan sponsors, claims administrators and other insurance industry clients

Advise about broker, agent, customer, and provider credentialing and licensure, management, compliance, training and contracting

Review, draft, negotiate and interpret group insurance, worker’s compensation insurance, stop-loss insurance, errors and omissions, directors and officers, and other insurance related contracts

Write coverage opinions

Counsel and representation on employment, independent contractor and other staffing matters, including re-engineering of people and processes, workforce realignment or downsizing, corporate reorganization and restructuring

Process reengineering and risk management

Advise employers, employee benefit plan sponsors, health care and managed care organizations, insurers, government officials, and others about legislative and regulatory reform and enforcement initiatives and public policy matters relating to employment, employee benefit, health care, worker’s compensation, tax and other matters including acting as an advisor to the Government of Bolivia on the reform of its pension and social security system as well as significant experience advising employers, health and managed care organizations, government officials and others in the United States and abroad about health care, social security, employment, pension and other legislative and regulatory proposals and developments

Advise and represent numerous accident & health, life and worker’s compensation insurers, managing general underwriters, brokers, third party administrators, PBMs, HMOs, PPOs 501A organizations, about product and process design, licensure, compliance, risk management, operations, and defense

Review and audit of computer and other protocols, claims investigation and documentation, settlement and other related procedures

Defense and response to appeals, governmental investigations, contractual disputes, member, and provider claims and lawsuits

Advise and represent insurance industry clients about internal human resources and employee benefit matters including compliance with federal and state laws, risk management of workforce related liabilities, workforce management, workforce reengineering, workforce reduction, compensation, employee benefits, outsourcing and employee leasing, internal investigations, and other human resource management matters

Advise insurance industry clients about broker credentialing, contracting, compliance and compensation

Advise, represent and defend clients about privacy and data security under HIPAA, FACTA, Gramm-Leech, state privacy and data security, and other applicable laws

Counsel and representation on employment liability, fiduciary liability and E&O insurers on ERISA and other fiduciary liability, officer and director, property casualty and other coverage and liability matters

Advise insurers, businesses and their leaders about loss and disaster preparedness, mitigation, recovery and other risk management strategies