Xavier’s practice includes a variety of health care regulatory compliance issues in health care transactions and business arrangements. He represents clients that are involved in, or invest in, the health care and life sciences industries.
He has a particular focus on regulatory and compliance issues related to the Affordable Care Act and federal health care programs such as Medicare, Medicaid, and TRICARE. He regularly advises health plans and other payor-side organizations participating in Medicare Advantage, Part D, and Medicaid Managed Care, and often advises health plans and related organizations on complex issues related to copay accumulators, copay maximizers, and alternative funding programs; utilization management and prior authorization; the 340B program; and risk adjustment and medical loss ratio. He also has experience with accountable care organization compliance and contracting, and has advised risk-based providers and organizations on compliance with state insurance requirements.
Xavier also provides regulatory counsel to private equity firms and other investors in mergers and acquisitions involving a variety of targets, including health systems and other health care providers, pharmacies, health insurance plans and pharmacy benefit managers, accountable care organizations, laboratories, health care technology companies, and risk adjustment vendors.
On behalf of health care providers (including health care facilities and agencies, physician groups, and veterinary practices), Xavier has extensive experience advising clients on compliance with corporate practice of medicine and fee splitting prohibitions, and state and federal licensure and regulatory filing requirements. He also routinely advises these and other health care industry clients on legislative and regulatory trends, including on issues such as drug pricing and risk adjustment.
While in law school, Xavier served as an intern in the US Department of Health and Human Services’ Office of Inspector General and Vermont Legal Aid’s Office of the Health Care Advocate. He also worked as a senior research assistant at The George Washington University Milliken Institute School of Public Health, where he contributed to projects around health care regulatory issues.
viewpoints
A Review of the Affordable Care Act at 10 Years
April 6, 2020| Blog|
Did the Tenth Circuit Just Put the Final Nail in the Coffin for Challenges to the Use of “Statewide Average Premium” in Risk Adjustment Methodologies?
January 8, 2020 | Blog | By Xavier Hardy
Health Care Forecast in Massachusetts from ML Strategies
November 15, 2019 | | By Xavier Hardy
Compounding Pharmacy and Private Equity Firm Owner Agree to $21 Million Settlement to Resolve FCA Allegations
September 20, 2019 | Blog | By Xavier Hardy, Karen Lovitch
CMS Proposes Changes to Medicare Advantage Program for CY 2020
February 6, 2019 | Blog | By Xavier Hardy, Bridgette Keller
New Mexico Court Affirms Ruling in ACA Risk Adjustment Case
November 6, 2018 | Blog | By Xavier Hardy
Court Rules that Federal Government Must Make Cost Sharing Reduction Payments to Insurers
September 12, 2018 | Blog | By Xavier Hardy
CMS, In a Reversal, Announces Plans to Continue Funding Risk Adjustment Payments
August 9, 2018 | Blog | By Xavier Hardy
Appeals Court Rejects Insurers Risk Corridors Claims
June 14, 2018 | Blog | By Xavier Hardy
Decision Expected Soon in Ongoing Risk Corridors Litigation
June 12, 2018 | Blog | By Xavier Hardy
News & Press
HHS Pushes Back on Accumulator Ruling, Prompting Wait-and-See Situation
December 21, 2023
MMIT quoted a recent article written by Mintz attorneys Theresa Carnegie, Xavier Hardy, and David Gilboa in a story discussing the US district court ruling that overturned a federal rule allowing health plans to exclude copayment assistance from members’ out-of-pocket costs. The article notes the Department of Health and Human Services’ current stance of refraining from immediate action.
Mintz Advises Kindred Healthcare in Sale to LifePoint Health, Launching ScionHealth
December 23, 2021
Mintz Advises Kindred at Home in $5.7 Billion Sale to Humana
August 23, 2021
Monopsony Issues in the Post-ACA World: How the Affordable Care Act May Impact Monopsony Analyses in the Review of Health Insurance Mergers
October 1, 2016
Events & Speaking
Involvement
- Member, American Health Lawyers Association