Marjorie T. Scher

Overview

Health care providers and managed care organizations know they can rely on attorney Marjorie Scher for practical and effective advice and counsel on commercial plans, Medicare, and Medicaid, as well as for help with contract drafting and analysis and regulatory research.

Passionate about ensuring broad access to health care, Marjorie has advised on a wide range of Medicaid and health equity-related matters. Before becoming an attorney, she worked as an office administrator in a prosthetics and orthotics practice, giving her firsthand exposure to the provider experience.

Marjorie understands both the provider and payor perspectives and the complexities of the network arrangements in the managed care space. Providers and payors turn to her for advice on forming and executing payor or provider relations strategies, creating and implementing value-based payment methodologies (including on the Anti-Kickback Statute Safe Harbors that may insulate participants from regulatory risk while in a value-based arrangement), and responding to payor audits and disputes. She also drafts complex value-based payment contracts incorporating concepts such as clinical integration, risk corridors on upside and downside risk arrangements, and opportunities for additional payment by meeting quality metrics.

In addition to her health care regulatory work, Marjorie maintains a robust pro bono practice, providing advice and counsel to nonprofit organizations. She currently serves as pro bono counsel to Heart of Passion, a summer camp experience for teens with cancer, where she also enjoys running programming throughout the year to train high school volunteers to work with this important population.

Prior to joining Epstein Becker Green, Marjorie’s practice focused on consulting for private equity firms interested in investing in providers with high Medicaid and Medicare exposure. At her previous law firm, Marjorie founded a research and policy team at the outset of the COVID-19 pandemic that analyzed the immense amount of new legislation and regulations affecting the Medicaid space.

Focus Areas

Services

Industries

Trending Issues

Health Equity

Experience

Provides ongoing contract negotiation support to a women’s health telehealth provider in its transition from a largely private-pay patient base to a largely Medicaid-managed care patient base. Marjorie also advises on a macro strategy for standardizing operations across several payors and geographies and the provider-friendly preferred provisions that should be in each payor contract.
Successfully represented a behavioral health provider in an appeal and termination of suspension from the Washington, DC, Medicaid program.
Represented a behavioral health provider in a multi-party payor audit, successfully avoiding a criminal referral for alleged submission of false claims while providing advice and counsel for bolstering the provider’s billing and coding practices.
Created a new model managed care contract for a state client after the client expressed concern that its existing contract did not comply with Centers for Medicare & Medicaid Services (CMS) requirements. Marjorie and her team’s new model contract complied with CMS requirements as well as the state's mental health parity, network adequacy, and alternative payment model goals. CMS intends to use the model contract as a best practice example in its Criteria for Medicaid Managed Care Contract Review and Approval.

Recognition

The Best Lawyers in America^©: “Ones to Watch” in Health Care Law (2024)

Credentials

Education

Tulane University School of Law (J.D., 2015)
- Senior Articles Editor, The Sports Lawyers Journal
- H. Martin Hunley, Jr. Award in Health Care Law
Tulane University School of Public Health and Tropical Medicine (M.H.A., 2015)
- Upsilon Phi Delta Honor Society
Binghamton University, State University of New York (B.A., 2011)