Janice H. Ziegler, Partner

Janice Ziegler is a partner in Sonnenschein’s national Health Care Group.  She focuses on providing strategic, regulatory and legislative counseling to clients regarding the Medicare Secondary Payer (MSP) laws, the Medicare Advantage and Medicare Part D programs, and federal and state health care privacy matters. With over 20 years of litigation and health care experience, Ms. Ziegler advises a broad range of health care businesses, including insurers and health plans, hospitals and health systems, physicians and physician practices, pharmacies and pharmacy benefit managers.

Ms. Ziegler is a nationally recognized MSP authority. She has advised insurers, providers, employers, and industry associations in all manner of MSP and coordination of benefits representations, including defending companies involved in False Claims Act litigation and regulatory enforcement matters, conducting comprehensive MSP compliance and operational reviews, providing legislative counseling, commenting on regulations, litigating challenges to MSP regulations, and performing MSP-related training.  Ms. Ziegler also advises clients on Section 111 mandatory reporting and strategies for MSP compliance and minimizing legal exposure.

Ms. Ziegler counsels clients extensively regarding the Medicare Advantage and Medicare Part D programs.  In addition to providing day-to-day regulatory advice and assisting clients with transactional matters, Ms. Ziegler has worked collaboratively with clients in the development of effective Medicare Advantage, Part D and corporate compliance programs.  She also counsels clients in connection with Centers for Medicare & Medicaid Services contract and enforcement activities, including responding to requests for corrective action plans, imposition of intermediate sanctions, and imposition of civil monetary penalties. 

Ms. Ziegler’s health care privacy experience includes counseling clients on state and federal privacy laws, including compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  Ms. Ziegler supervised and actively participated in the development of a comprehensive 54 jurisdiction HIPAA preemption analysis.

Before beginning private practice, Ms. Ziegler clerked for the Honorable John H. Pratt, United States District Court for the District of Columbia.  Ms. Ziegler is a Vice Chair of the American Health Lawyer’s Association Medicare Part D Task Force and serves as a liaison to the Fraud and Abuse practice group.  She is a frequent author and lecturer on emerging issues relating to the MSP laws, the Medicare Advantage and Part D programs, and health care privacy issues.

American Health Lawyers Association, Part D Task Force Vice-Chair and Liaison for Fraud and Abuse Practice Group

American Bar Association:  Health Law Section

“When Does a Sponsor’s ‘Promise to Pay’ in the Clinical Trial Setting Trigger Medicare Secondary Payer Liability?,” BNA Medical Research Law & Policy Report (Vol. 6, No. 20) (October 17, 2007).

“The Medicare Secondary Payer Statute:  A New Spear in the Government’s Fraud and Abuse Arsenal?”  Blue Cross Blue Shield Association, Legal Affairs Bulletin (No. 943) (August 2004).

“Stark II, Phase II – Highlights and Preliminary Analysis,” BNA Health Law Reporter (Vol. 13, No. 14) (April 1, 2004).

Co-author:  “Provider Sponsored Organizations:  Providers Searching for Opportunity,” Chapter 2 of an Aspen Publication entitled, Provider Sponsored Organizations Emerging Opportunities for Growth (1998).

"Understanding the May 26, 2010, CMS Medicare Secondary Payer Clinical Trial Alert," Health Care Compliance Association Teleconference (July 27, 2010).

"Medicare Secondary Payer Issues," AHLA Institute on Medicare and Medicaid Payment Issues Conference (March 25, 2010).

“Medicare Risk Adjusters:  A New Frontier and Potential Legal Issues for Plans and Providers—Legal Challenges Posed by Medicare Risk Adjusters,” AHLA Payors, Plans and Managed Care Practice Group and Part D Task Force Teleconference (June 16, 2009).

“Advanced MSP Roundtable - Navigating the MSP Maze: Understanding the New Legal Landscape and Working with the COBC and the MSPRC,” Blue Cross Blue Shield Association Lawyer’s Conference (May 7, 2009).

“Medicare Secondary Payer Issues and Developments,” AHLA Institute on Medicare & Medicaid Payment Issues Conference (March 25, 2009).

“Avoiding Non-Compliance and Regulatory Issues Involving Risk Adjustment,” Medicare Health Care Compliance Association Management Conference (November 10, 2008).

“Medicare Secondary Payer Issues and Developments,” AHLA Institute on Medicare & Medicaid Payment Issues Conference (April 9, 2008).

“Tips for Conducting Internal Investigations,” Health Care Compliance Association Medicare Part D Compliance Conference (December 10, 2007).

“Implications of the Medicare Advantage Program for Hospitals,” Tennessee Hospital Association Seminar (April 18, 2006).

“Recent Medicare Secondary Payer Enforcement Initiatives,” Blue Cross Blue Shield Association Compliance and Ethics Conference (March 15, 2006).

“Understanding the Medicare Advantage Program:  Implications for Hospitals,” Metropolitan Chicago Healthcare Council Seminar (January 23, 2006).

“Pharmacy Promotional Activities Relating to Medicare Part D:  Beyond the Marketing Guidelines,” NACDS Foundation Update on Medicare Parts B and D Conference (October 26, 2005).

"Medicare Advantage," American Hospital Association Teleconference Series (4-Part Series) (Fall 2005).

"Payer Tag – Playground Rules for Coordinating with Medicare," Blue Cross Blue Shield Association Lawyers' Conference (May 8, 2003).

"Medicare Secondary Payer Issues: Who's on First?" National Other Party Liability Group (NOPLG) Conference (April 23, 2003).

“Medicare Secondary Payer Data Match Initiative:  Something Old and Something New,” BCBSA Lawyers Conference (May 2002).

“Jumping Through Two Hoops:  HIPAA and State Law Compliance,” BCBSA Lawyers Conference (May 2002).

“The HIPAA Privacy Rule and State Law Compliance Issues,” BCBSA - HIPAA Summit (July 30, 2002).