Why Paulette?

Paulette has represented both healthcare providers and payors. Her litigation experience includes matters in state and federal courts, administrative hearings, and complex multi-million-dollar arbitrations. I have also handled and resolved payor audits involving both government and commercial payers, including payor Special Investigations Units (SIUs) and government audits conducted by ZPICs, MFCU, and CMS contracted audit entities.

Although she began her career as a trial attorney, she has developed a substantial contract practice over the years. She has negotiated and drafted multimillion-dollar agreements for health plans, large IPAs, MSOs, vendors, and healthcare systems and providers.

Recent Representations include:

1. RubyWell ™— Providing strategic advice to a woman-founded healthcare startup with a mission of finding funding for care navigator services that assist the patient and the family caregiver through negotiations with Government and Commercial payers to increase its revenue sources and expand nationally.

2. Know Your Worth ™ – Providing corporate and governance assistance in helping the team set up their entities and respective operating agreements, agreements with investor/advisors and provide advice on how, as a new entity, to govern themselves. KYW’s mission is to provide individual providers with the data and knowledge about their performance to allow them to negotiate better contracts with payors.

3. Pennsylvania Medical Society’s Clinical Integrated Network — Drafted and negotiated contracts with payors and with strategic vendors.

4. Management Services Organization — Serviced an MSO with several provider groups that contract nationally with skilled nursing facilities, vendors, and suppliers, with contract drafting, contract management, and development and implementation of its contract management system.

5. DME Supplier — Represented a DME supplier in an administrative hearing involving a unique coding issue with potential national impact. (pending)

6. SOMOS Innovation — Advised SOMOS Innovation’s MSO in its implementation of various delegated functions (e.g., network contracting, claims payment processing, utilization management, care management, and network expansion) and provided services including contract negotiations, redlined and finalized contracts with payors in New York State and providers to expand the IPA network.

Paulette’s Background

Paulette Wunsch is an experienced healthcare attorney with more than 25 years of experience in the healthcare sector. She has served as General Counsel, Equity Partner, Chief Compliance Officer, and Assistant U.S. Attorney. Her experience spans healthcare providers, payors, health plans, and other healthcare organizations, giving her a broad perspective on the legal, regulatory, operational, and business issues that affect healthcare entities. She advises CEOs and other senior executives on enterprise risk, high-stakes investigations, litigation, regulatory strategy, and complex healthcare transactions and contracting matters. She also advises investors and founders of healthcare start-ups on approaches to increasing revenue from payors.

From 2002 through 2015, Paulette held senior leadership positions with government and commercial health plans and payor/provider organizations, including UnitedHealthcare, WellCare, Nippon Life, Blue Cross and Blue Shield of Florida, EverCare, and VNS Health. In these roles, she gained extensive experience addressing the legal and regulatory challenges faced by both payors and providers.

Since 2016, Paulette has practiced with the law firms Bleakley Platt & Schmidt and Lichtman Law, and earlier in her career with Day Pitney, representing healthcare providers in government investigations, regulatory audits, contracting matters, litigation, and regulatory compliance. Her practice has included advising clients on complex healthcare regulatory matters and representing providers in government investigations and enforcement matters, including proceedings before the U.S. Department of Justice, various U.S. Attorney Offices, the U.S. Department of Health and Human Services, the Office of Inspector General, offices of State Attorneys General, as well as investigations conducted by the Federal Bureau of Investigation, Medicaid Fraud, Control Unit, and audits brought by the Centers for Medicare & Medicaid Services, and their contracted auditors, and by payor Special Investigations Units.

Paulette has extensive experience advising clients on federal and state healthcare laws and regulations, including the Anti-Kickback Statute, False Claims Act, Stark Law, Corporate Practice of Medicine, antitrust laws, HIPAA, and related healthcare regulatory requirements.

Earlier in her career, from 1987 through 1999—with a period between 1990 and 1991 when she served as an associate professor in the Political Science Department at Fordham University—Paulette held state and federal prosecutorial positions. She served with distinction at the U.S. Department of Justice, where she received the Barrister Award from the Attorney General. She also served under Mary Jo White in the U.S. Attorney’s Office for the Southern District of New York, where she was one of the founding members of its Health Care Fraud Task Force.

Paulette received her undergraduate degree from the University of Chicago in 1983 and her Juris Doctor (J.D.) from Benjamin N. Cardozo School of Law, Yeshiva University, in 1986. She later received a Master of Laws (LL.M.) from Columbia University School of Law in 1990. She is admitted to practice in the state and federal courts of Connecticut and New York.

Paulette is a trained as an arbitrator by the American Health Law Association and will be listed on their roster as a neutral arbitrator.