Alexandra Lucas

Alex is a highly experienced advisor in health care compliance and regulatory matters, serving managed care organizations (MCOs) nationwide. She provides guidance on compliance with significant legislation such as the Consolidated Appropriations Act of 2021, as well as laws governing reproductive care, gender-affirming care, and a variety of government program requirements. Her skill set extends to addressing compliance issues specific to Medicare Advantage Organizations, Medicaid Managed Care Organizations, Marketplace products, and Employee Retirement Income Security Act (ERISA) plans and administrators.

Alex is widely recognized as a national authority on the No Surprises Act (NSA) and its impact on MCOs. She counsels clients on a broad range of NSA compliance matters, manages the administration of the NSA’s independent dispute resolution process for multiple organizations, and supports both internal and regulatory audits to ensure ongoing compliance. Her advisory work also covers compliance with Transparency in Coverage rules, Medicare Advantage marketing regulations, provider directory requirements, medical loss ratio reporting, privacy and interoperability standards, and both state and federal benefits mandates. Beyond her advisory work, Alex leverages her deep knowledge of the NSA to represent MCOs in litigation involving the IDR process, including defending against lawsuits seeking to enforce IDR awards. She also provides strategic counsel to MCOs aiming to address improper practices in the IDR process and has experience representing them in related litigation.

In addition to her advisory role, Additionally, Alex represents MCOs in litigation and arbitration, including cases involving ERISA and government program compliance, contractual payment disputes with hospital systems and providers, and high-volume claim disputes with out-of-network providers.

What sets Alex apart is her deep industry knowledge and her mastery of the subject matter, which extend well beyond legal analysis. She possesses a thorough understanding of procedural and diagnosis coding, payment methodologies such as diagnosis-related groups and the outpatient prospective payment system, National Correct Coding Initiative edits, utilization management, front-end claim processing, actuarial considerations and the operational implementation of coverage requirements. This comprehensive perspective enables her to provide practical, effective solutions tailored to the complex needs of managed care organizations.