Lindsey Brown Fetzer
As chair of the firm’s multi-disciplinary Managed Care practice, Lindsey Fetzer has a deep understanding of the managed care industry and partners with her clients to provide strategic guidance and solutions in this ever-evolving area. She has extensive experience working with healthcare plans, risk-bearing provider groups, and vendors, in litigation, investigation, and compliance counseling matters. She has conducted dozens of investigations and compliance audits pertaining to issues such as Medicare Advantage risk adjustment, alleged kickback schemes, sales and marketing practices, and quality reporting metrics.
Memberships
American Bar Association
American Health Law Association (AHLA)
Women’s White Collar Defense Association
Representative Experience
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Representation of a national healthcare company in an investigation related to allegations of fraudulent risk adjustment coding practices. Matter involved government disclosure and an analysis of data correction obligations.
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Representation of a Medicare Advantage Organization in an investigation related to data-driven coding anomalies and practices detected at a large contracted provider group.
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Representation of a Medicare Advantage Organization and its wholly-owned provider group in an internal investigation related to allegations of improper coding practices, hostile work environment, and non-compliance with Medicare requirements.
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Representation of a Fortune 50 healthcare company in conducting oversight of network provider marketing practices and compliance with Medicare marketing regulations.
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Representation of a Medicare Advantage plan in multiple internal investigations related to its grievance and appeal procedures.
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Representation of a large national healthcare company in its defense of a FCA qui tam involving its wholly-owned Pharmacy Benefit Manager. After extensive negotiation, DOJ declined to intervene in the matter. The relator pursued the case independently, which resulted in a favorable resolution to our client.
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Representation of a national managed care organization in an internal review of potentially improper home health and hospice discharge protocols.
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Representation of a managed care organization in a review of whistleblower allegations related to the post-acquisition integration of a specialty pharmacy. The matter involved an assessment of risk specific to data privacy obligations.
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Representation of a Fortune 50 healthcare company in its response to a third-party grand jury subpoena.
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Representation of a Fortune 50 healthcare company in its response to a third-party grand jury subpoena.
Publications
Past Events
Media Mentions & Firm News
Accolades
Best Lawyers® : Ones To Watch — Health Care Law (2021-2023)
Best Lawyers® : Women In The Law Ones To Watch (2021)
Thomson Reuters — Stand-Out Lawyer (2023)
The Wall Street Journal Best Lawyers in DC Ones To Watch (2021)
Washington, D.C. Super Lawyers “Rising Star” (2015-2022)
The Washington Post Top Attorneys Rising Stars in Washington D.C. (2015 & 2020)
Washington and Lee Journal of Civil Rights and Social Justice — Lead Articles Editor
