Kristin J. Jones, CIPP/US


Kristin Jones


Kristin Jones provides regulatory, compliance and reimbursement counsel to health care providers (including hospitals, health systems and physician practices) and insurers. She counsels clients who operate in a highly regulated environment and is skilled at providing practical advice about complex regulatory schemes.

She regularly advises clients on government-funded insurance programs (such as Medicare and Medicaid), and related state health information privacy and security laws, licensing laws, and regulatory strategies. She has experience drafting provider agreements, preparing insurance regulatory filings and counseling insurers on federal compliance obligations under Medicare and Medicaid contracts. Kristin’s representation of health care providers includes providing guidance on the Anti-Kickback Statute, False Claims Act, Stark Law, patient safety and reporting obligations, and provider licensing laws. She has extensive experience analyzing physician compensation arrangements, compliance programs, reimbursement and billing, licensure, self-disclosure and reporting obligations, and other legal assessments and audits. Kristin also has advised clients regarding Pennsylvania's medical marijuana law.

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Representative Matters

  • defended health care providers and DME-POS suppliers in overpayment disputes with Medicare and other payors at all levels of administrative and judicial appeal, including an appeal of Medicare’s multimillion-dollar overpayment determinations before an Administrative Law Judge
  • advised clients on the impact of the Section 1557 regulations, which governs nondiscrimination in health programs or activities
  • represented a nationwide health care provider on managing regulatory and compliance risks arising from informed consent documents, record retention obligations, use of clinical photography, patient admission procedures and licensure requirements
  • counseled a health system on its obligation to report health care providers to state licensing boards
  • advised health care clients on a variety of health information privacy and security matters, including breaches, HIPAA policies and business associate agreements
  • advised a specialty medical service provider on out-of-network billing strategies and on other reimbursement and billing matters
  • interpreted the terms of state contracts for medical assistance programs, including Pennsylvania HealthChoices (Medicaid), Community HealthChoices (long-term care), and Children’s Health Insurance Program, and counseled managed care organizations on a myriad of issues arising from program terms
  • developed and implemented compliance plans, as well as individual policies and procedures, based on the Centers for Medicare and Medicaid Services and Office of the Inspector General regulations, federal and state law, and The Joint Commission requirements
  • counseled a lender financing health care facilities across the United States on health care regulatory matters such as changes of ownership and enrollment, state and federal audits of the target facilities, and obtaining a security interest in receivables under federal benefits programs
  • drafted asset purchase agreements, operating agreements, and related documents for a health system’s purchase of a physician practice
  • counseled clients on e-discovery and record retention issues, especially involving the collection, review and production of documents containing health information protected by HIPAA
  • analyzed business deals and specialty services – from insurance offerings to student health services to financing opinions – to counsel clients on the impact of federal and state health care laws and regulations
  • defended pharmaceutical companies and medical device manufacturers in products liability matters, including medical causation, and product identification issues and mass tort litigation
  • analyzed the effect of various components of the Affordable Care Act as applied to both providers and payors
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Bar Admissions
  • Pennsylvania
  • New Jersey
Court Admissions
  • Pennsylvania Supreme Court
  • U.S. District Court for the Eastern District of Pennsylvania
  • U.S. District Court for the District of New Jersey
  • J.D., cum laude, Temple University Beasley School of Law
  • B.A., Brown University
  • IAPP Certified Information Privacy Professional (CIPP/US)

  • American Bar Association
  • American Health Lawyers Association
  • Health Care Compliance Association

Speaking Engagements

  • Panelist, “Security Audits 2018: Keeping Up With the Questions!” ILTACON 2018 Annual Education Conference  
  • Presenter, “Ethical Obligations of Counsel in the Wake of a Data Breach,” Association of Corporate Counsel Greater Philadelphia/Delaware Valley Chapter 
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In The Community

Kristin is active in the Philadelphia community. She is dedicated to assisting the local chapter of the American Red Cross and, in furtherance of those efforts, acts as a member of the Donor Recruitment Committee, co-chair of Legal Initiative and co-chair of the Stradley Ronon Blood Drive Committee.
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