Andrea has more than 25 years of experience in the healthcare industry in various counsel, consulting and leadership roles. She serves clients inside and outside of Pinnacle, providing assistance with compliance strategy, risk management, due diligence, investigations, and litigation.
Before joining Pinnacle, Andrea was a Partner in the corporate practice group and healthcare industry team for a large national law firm, and a Partner and Chief DEI Officer at a well-known national healthcare valuation and consulting firm, where she led service lines focused on value-based care structures (including clinically integrated networks (CINs), accountable care organizations (ACOs), and Hospital Quality and Efficiency Programs (HQEPs); clinical research compensation; provider staffing for public hospitals and health systems/special taxing districts; provider recruitment and retention planning for shortage areas; and recruitment and contracting for academic/thought leader physicians.
Her prior professional experience also includes additional private law practice in the corporate and healthcare practice group of a global Am law 100 firm, serving as associate general counsel of a public health system/special taxing district that delivered rural and regional trauma care, and working in the in-house legal department of an urban academic medical center. Before becoming an attorney, she managed clinical trials and healthcare quality and patient safety research for nearly seven years.
Andrea’s practice experience is national in scope and includes providing transactional, operational, governance, and dispute resolution support for a broad array of nonprofit, for-profit, and governmental clients, including hospitals and health systems, physicians and physician groups, clinical laboratories, and pharmaceutical and medical device vendors, distributors, and manufacturers. She has assisted clients with structuring, documenting, managing, and, when appropriate, defending financial arrangements involving healthcare providers, often with attention to requirements and implications of the Stark Law, Anti-kickback Statute, False Claims Act, non-profit tax regulations, Foreign Corrupt Practices Act and/or the various state laws concerning billing, payment and corporate practice of medicine. Her work has included assisting clients with mergers and acquisitions, affiliations, joint ventures, public-private partnerships, enterprise-level compliance programs, and healthcare workforce recruitment and management arrangements, including significant incentive, independent contractor, and employment arrangements that exceed $1 million in annual compensation. Her work has also included outside general and special counsel services for healthcare clients, focusing on their contracting and compensation practices.
In addition to assisting clients in significant transactions, investigations, litigation, and compliance planning, Andrea utilizes her public health training to assist clients with post-pandemic population health strategies, including protocols for health services staffing and compensation, emergency preparedness and response, and the promotion of health equity.
Andrea brings to her work broad healthcare industry experience and unique perspective on the common regulatory requirements of fair market value and commercial reasonableness, which she developed through her years as both counsel and valuation professional. She is able to issue, spot, and provide practical solutions-focused advice by drawing on her combined experience. She has had the privilege to work with some of the largest health systems, physician groups, and life sciences companies in the United States, as well as numerous Fortune® 500 and Fortune® 100 companies and False Claims Act defense counsel.
Andrea is a frequent author, speaker, and instructor on topics related to fair market value and commercial reasonableness and their role in healthcare regulatory compliance, investigations and litigation. She has authored more than 100 publications and presentations on related topics for national organizations such as the American Health Law Association, American Bar Association, and Health Care Compliance Association, and has served as a consulting or testifying expert in several recent matters.
Andrea is a member of the Florida Bar and National Association of Certified Valuators and Analysts (NACVA), and a former Licensed Healthcare Risk Manager and Clinical Research Coordinator. She is a longtime member of the American Health Law Association, in which she has served in numerous leadership roles, including chairing the Fair Market Value Affinity Group and the Public Hospitals and Health Systems Affinity Group. In 2021, she completed training to be a Certified Diversity Executive (CDE).
Andrea received a Juris Doctor with a certificate of concentration in Health Law from Boston University School of Law, a Master of Public Health with a concentration in Health Law and secondary focus in epidemiology and biostatistics from Boston University School of Public Health, and a bachelor’s degree in Economics from Smith College.
Publications:
- “Understanding the Implications of the Supreme Court’s June 2022 Decision in Ruan,” Jones Walker LLP Healthcare Client Alert, September 6, 2022
- “Update on Risks of Payments in Arrangements With Telemedicine Companies: OIG Warns of Prosecution Risks and Identifies Seven Criteria for Caution When Entering Into Telemedicine Payment Arrangements, and the Advancing Telehealth Beyond COVID-19 Act Passes the House and Goes to the Senate, Suggesting Extended Revisions to Medicare Payment Rules for Telehealth Services,” Jones Walker LLP Healthcare Client Alert, August 24, 2022
- “Developments in the Quest to Advance Equity in Maternal and Child Health in the Age of COVID-19: The Bad, the Good, and the Promising,” The Journal of Health and Life Sciences Law published by The American Health Law Association, May 2022
- “Eliminating Health Disparities by Diversifying the Provider Workforce,” HealthCare Appraisers FMVantage Point, December 14, 2021
- “Financial Stabilization and Recovery for Rural and Safety Net Hospitals Post
COVID – New Developments and Options Going Forward,” American Health Law Association Member Briefing, September 22, 2021
- “The Long Awaited New Stark and Anti-kickback Final Rules: New Definitions for Commercially Reasonable, Fair Market Value and Taking into Account the Volume or Value of Referrals: What Do They Mean for Physician Compensation?” Healthcare Appraisers FMVantage Point, December 2020
- “The Value of Fair Market Value Review in a Hospital’s Preparation and Response to Coronavirus,” Healthcare Appraisers FMVantage Point, March 2020
Presentations:
- “Building and Operating an Effective Health Care Corporate Compliance Program,” Boston University School of Law’s Seminar, 2022
- “Due Diligence for Compensation Compliance: Mitigating Risk in Financial Relationships and Healthcare Transactions,” Strafford Publications Webinar, November 8, 2022
- “Developments in the Quest to Advance Equity in Maternal and Child Health in the Age of COVID-19: The Bad, the Good and the Promising,” American Health Law Association’s podcast series “Speaking of Health Law”, October 14, 2022
- “Healthcare Investigations, Prosecutions, and Compliance Strategies: New.Developments and Hot Topics,” Strafford Publications, September 7, 2022
- “DEI or DIE: Case Studies in What We’ve Learned About the DEI Imperative in the Post COVID Transition,” American Health Law Association (AHLA) Annual Meeting, June 28 and 29, 2022
- “A Hidden Minefield? Navigating Legal and Compliance Risks in Research Budgeting and Compensation,” Health Care Compliance Association’s Research Compliance Conference, June 9, 2022 “Physician Compensation After Changes to the Stark Law and Anti-kickback Statute Regulations: The View from 2022,” Strafford Legal Webinars, April 7, 2022
- “Fair Market Value in Health Care – the Ninth Annual Year in Review: A New Starkly Different Post-COVID World, One Year Later,” American Health Law Association Physicians and Hospitals Law Institute, February 3, 2022
- “Care Coordination, Clinical Integration and Physician Incentives after Stark Law and Anti-kickback Statute Rule Changes,” Strafford Legal Webinars, October 18, 2021
- “The Terrible, Horrible, No-Good Very Bad Year: How Did We Do and Where Do We Go From Here? Understanding the Strides and Obstacles to Workforce Diversity and Inclusion Through the Lens of COVID,” American Health Law Association Annual Meeting, June 30, 2021
- “Physician Compensation After 2020 Changes to the Stark Law and Ant-Kickback Regulations: FMV, Commercial Reasonableness and Volume or Value Standards, Part II,” Strafford Legal Webinars, May 14, 2021
- “Highway to the Danger Zone: Compliance Related Transactional Challenges and Options to Overcome Them for Hospitals in Distress,” American Health Law Association Health Care Transactions Conference, April 16, 2021
- “Looking Back and Looking Ahead at Physician Compensation: The View After Stark and Anti-kickback Changes,” Institute for Continuing Legal Education, 27th Annual Health Law Institute, April 16, 2021
- “Physician Compensation After 2020 Changes to the Stark Law and Anti-Kickback Regulations: New FMV, Commercial Reasonableness and Volume or Value Standards, Part I,” Strafford Legal Webinars, February 24, 2021
- “Fair Market Value in Health Care—The Eighth Annual Year in Review: A New Stark-ly Different, Post-COVID World,” American Health Lawyers Association
Physicians and Hospitals Law Institute, February 12, 2021
- “Compensation Arrangements with Rockstar Physicians: Key Legal and Fair Market Value Considerations in the Age of COVID-19,” Strafford Legal Webinars, December 10, 2020
- “Medical Directorships: Key Considerations, Fraud and Abuse Compliance, and Lessons from Recent Enforcement,” Strafford Legal Webinars, October 20, 2020
- “Rural Healthcare and COVID-19, Part II,” Podcast, American Health Lawyers Association, August 21, 2020
- “Structuring and Managing Clinically Integrated Networks—The View from 2020: What’s New and What Do We Do Now?” Strafford Legal Webinars, August 18, 2020
- “Structuring and Implementing Physician Incentives in the Age of the COVID-19 Public Health Emergency,” Strafford Legal Webinars, June 25, 2020
- “Designing Transitional Compensation Models During the COVID-19 Public Health Emergency,” webinar, American Health Lawyers Association, May 14, 2020
- “Convergence and Collaboration—The Partner or Perish or Partner and Perish Dilemma: Special Legal and Regulatory Considerations for Achieving Integrated Care with Tax-Supported, Non-Profit, Rural and Other Safety Net Health Systems,” American Health Lawyers Association webinar, May 7, 2020
- “Navigating the Danger Zone: Transactional Decisions for Hospitals in Distress,” American Health Lawyers Association Health Care Transactions Virtual Conference, April 22, 2020
- “Rural Healthcare and COVID-19, Part I,” podcast, American Health Lawyers Association, April 15, 2020
- “Preparing for and Responding to Patient Surges: Addressing Space, Supplies and Equipment,” podcast, American Health Lawyers Association, April 8-15, 2020
- “Lessons from Hahnemann University Hospital: What We Can Learn About Operational Questions, Legal Options and Danger Zones for Hospitals in Distress,” American Health Lawyers Association, March 24, 2020
- “FMV, Commercial Reasonableness and Other Provisions of the Recent Proposed Stark Rules—What Might They Mean for Provider Compensation Going Forward?” Emerging Issues in Health Law, American Bar Association, March 2020
- “Fair Market Value in Health Care—The Seventh Annual Year in Review: A Whole New World or Just the Triple Grand Slam in the Middle of the World Series?”, February 10-12, 2020
Representative Projects
- Assisting clients in the transition to value-based payments, including structuring, evaluating and identifying issues in compensation plans and incentive payments made in the context of coordinated care and alignment strategies, such as formation of clinically integrated networks, accountable care organizations, gainsharing arrangements and “Hospital Quality and Efficiency Programs”
- Compliant financial arrangements in clinical research and clinical trial agreements, including assisting clients with budgeting for clinical research and planning provider compensation in the context of clinical research and clinical trial agreements
- Provider recruitment and retention strategies, including income guarantees and recruitment bonuses for providers in shortage areas
- Compensation and contracting in public and tax-supported provider organizations, including public hospitals and health systems and trauma systems
- Compensation for academic, teaching and uniquely experienced Thought Leader and “Rockstar” physicians
- Compensation in pharmaceutical and medical device consulting agreements
- Physician medical director and consulting agreements, including having served as the expert author on medical director arrangements for multiple editions of the AHLA/BVR Guide to Healthcare Valuation
- Compensation for physician services in the context of graduate medical education and teaching
- Fair market value analysis for due diligence and litigation support
- Hospital service-line management agreements
- Commercial reasonableness questions related to unusual payment arrangements with providers
- Diversity, equity and inclusion and its intersection with compensation
Professional Designations and Affiliations
- American Health Lawyers Association (AHLA)
- Vice Chair, the AHLA/NACVA Work Group
- Member, Hospitals and Health Systems Practice Group
- Member, Academic Medical Centers Practice Group
- Member, Life Sciences Practice Group
- Member and author, Fraud and Abuse Compliance Committee
- Member, Best Practices for Health Law Curriculums Work Group
- American Bar Association, Health Law Section
- Florida Bar, Health Law Section
- American Public Health Association
- National Association of Certified Valuators and Analysts (NACVA)
