Overview
Attorney Marjorie Scher concentrates on Medicaid managed care, Medicare Advantage, and value-based enterprises. Health care providers and health plans rely on her for practical and effective strategic advice and counsel, help with contract drafting, and complex regulatory analyses.
Marjorie understands both the provider and payor perspectives, as well as the complexities of the network arrangements in the managed care space. Providers and payors alike turn to her for advice on forming and executing network contracting strategies, creating and implementing value-based payment methodologies, and responding to payor audits and disputes. As part of this work, Marjorie drafts complex value-based payment contracts with an eye towards drafting and advocating for the legal protections necessary for each party to achieve their business goals.
In addition to her managed care work, Marjorie stays up to date on key Medicare and Medicaid policy developments, including Centers for Medicare & Medicaid Services (CMS) approval of innovative 1115 waivers and Center for Medicare and Medicaid Innovation (CMMI) implementation of pilot programs. Most recently, Marjorie has advised clients on entering value-based enterprise contractual arrangements, through which two or more parties can creatively exchange funds, services, and referrals using the protection of the recent value-based safe harbors under the federal Anti-Kickback Statute. Marjorie also advises clients on how to work within the federal health care program regulatory constructs to creatively improve health care delivery in a compliant way.
Prior to joining Epstein Becker Green, Marjorie’s practice focused on consulting for private equity firms interested in investing in providers with significant Medicaid and Medicare populations. She previously 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 program. Before becoming an attorney, she worked as an office administrator in a prosthetics and orthotics practice, giving her firsthand exposure to the provider experience.
What Marjorie Delivers for Clients
- Deep Industry Insight: Marjorie draws on her firsthand experience in a provider’s office to inform her counsel, offering a well-rounded perspective that considers both the provider and payor sides of health care arrangements.
- Strategic Contract Negotiation: She drafts and negotiates complex managed care and value-based payment contracts with a focus on implementing the legal protections necessary for each party to achieve its business objectives.
- Proactive Regulatory Counsel: Clients receive forward-thinking guidance on navigating intricate federal and state regulations, including CMS pilot programs and innovative 1115 waivers, to improve health care delivery compliantly.
- Effective Dispute Resolution: When disputes arise, she represents providers or payors with an emphasis on reaching collaborative settlements as a constructive alternative to litigation.
Experience
- Provides ongoing contract negotiation support to a range of provider clients as they join Medicaid managed care, Medicare Advantage, and commercial payor networks. Contracting efforts range from straightforward participating-provider agreements to complex risk-sharing and outcomes-based arrangements.
- Prepares various value-based enterprise agreements for clients endeavoring to provide no-cost patient engagement tools under the Patient Engagement and Supports safe harbor, and to provide care coordination under the Personal Services safe harbor.
- Represents providers or payors in disputes, with a focus on a collaborative settlement as an alternative to litigation.
- Advises clients on CMMI pilot programs, including:
- the Medicare Shared Savings Program (MSSP);
- the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) program;
- the Guiding and Improved Dementia Experience (GUIDE) model;
- the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model;
- the Wasteful and Inappropriate Service Reduction (WiSER) model; and
- the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE).
- Advises New York provider clients on funding opportunities under the New York 1115 waiver and supports clients in contract review and negotiations to participate in the waiver.
- Serves as regulatory counsel in private equity due diligences of provider, third-party administrator, payor, and revenue cycle management company targets.
- Co-led an integrated effort between Epstein Becker Green and its consultant affiliate, EBG Advisors, to take a health plan client through its initial National Committee for Quality Assurance (NCQA) accreditation survey, including revising policies, preparing quantitative and qualitative analyses, and managing key interactions with NCQA surveyors.
- 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 improving 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 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 to 2026)
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)
Bar Admissions
- New York
Professional & Community Involvement
- Heart of Passion, Pro Bono Counsel
Focus Areas
Services
Trending Issues
Events
Media
Insights
Insights
- PublicationsCMS’s MAHA ELEVATE Model: Integrating Whole‑Person Care into Original Medicare10 minute read
- BlogsACCESS Model: CMMI’s New Technology-Enabled Chronic Care Model4 minute read
- PublicationsCMS Seeks to Ban Hospitals from Providing Gender-Affirming Care to Minors17 minute read
- BlogsCMS Attempts to Use Medicare and Medicaid Conditions of Participation to Ban Hospitals from Providing Gender-Affirming ...8 minute read
- Firm Announcements
Epstein Becker Green Attorneys Honored for Excellence in the Legal Profession by Best Lawyers 2026
12 minute read - PublicationsSupreme Court Upholds Tennessee’s Ban on Gender-Affirming Care20 minute read
- BlogsCMS Tells States “No More” Medicaid Section 1115 Matching Funds for Designated State Health Programs (DSHP) and ...7 minute read
- PublicationsProtecting Newborns from RSV: Opening a Reimbursement Pathway2 minute read
- BlogsGlobal Hospital Budgets: A New Trend?5 minute read
- Media CoverageMarjorie Scher Quoted in “Will Medicaid Incarceration Waivers Hit 'Cutting Room Floor'?”2 minute read
- Firm Announcements
Epstein Becker Green Attorneys Honored for Excellence in the Legal Profession by Best Lawyers 2025
14 minute read - PublicationsCMS Issues Mandatory “TEAM Model” for Acute Care Hospitals to Improve Episode-Based Alternative Payments and Advance ...17 minute read
- PublicationsFinal Medicaid Managed Care Rule Updates Requirements Regarding Access, Finance, and Quality16 minute read
- Media CoverageMarjorie Scher Quoted in “Citing U.S. Supreme Court Decision, Health System Sues Medicare Advantage Plan for Past 340B ...4 minute read
- PublicationsNew Coverage, Delivery, and Payment for Health-Related Social Needs Services Under New York’s Approved 1115 Medicaid ...13 minute read
- BlogsAn Overview of the CMS Approved New York 1115 Medicaid Waiver12 minute read
- PublicationsHospital and MA Plan Considerations for CMS Final Rule to Remedy 340B Drug Payment Policy11 minute read
- BlogsCMS Adds Place of Service to Allow Additional Flexibility in Delivering Medicare and Medicaid Healthcare Services to the ...7 minute read
- BlogsNavigating the New New York Department of Health Regulation on Facility Fees9 minute read
- Firm Announcements
Epstein Becker Green Attorneys Recognized by 2024 Best Lawyers for Excellence in the Legal Profession
12 minute read - BlogsCMS Forwards Its Health Equity Agenda Through Its Annual Prospective Payment System Rulemaking Process5 minute read
- BlogsThe Joint Commission’s 2023 Focus on Health Equity4 minute read
- Publications2023 Physician Fee Schedule Final Rule Supports Health Equity Through Investments in Accountable Care Organizations ...12 minute read
- Publications
In Wake of Dobbs Decision, CMS Issues Guidance to Hospitals on EMTALA Obligations
12 minute read