James F Novello
Government and Commercial Contracting
Mergers and Acquisitions
State and Federal Regulatory Compliance
Gonzaga University School of Law
Juris Doctorate 1992
University of San Francisco
Bachelor of Science in Economics and Organizational Management
For over 20 years, Jim has addressed the legal, regulatory, and business issues facing health insurers and managed care companies throughout the country. His rare experience as a senior executive in both the legal and business side of government sponsored healthcare, as well as his time as a former regulator provides a unique perspective for his clients. Today, Jim is recognized as a leading expert on issues facing health insurers and managed care organizations serving Medicaid and Medicare beneficiaries, as well as enrollees of the State Healthcare Exchanges.
Early in his legal career, Jim was a Deputy District Attorney prosecuting those entities committing insurance fraud. Recognized for his courtroom advocacy, Jim was tapped by then Governor Gray Davis to lead the California Department of Managed Health Care’s Enforcement Division, the nation’s only independent HMO regulator. As the Department of Managed Health Care’s Chief Prosecutor, Jim was responsible for ensuring compliance with those state and federal laws regulating HMOs and other managed care organizations.
Most recently, Jim was Senior Vice President and Deputy General Counsel at Molina Healthcare, Inc. Molina, one of the nation’s largest managed care organizations, serves the nation’s Medicaid and Healthcare Exchange populations. Prior to joining Molina, Jim served as Senior Vice President and General Counsel at Arcadian Health, a Medicare Advantage plan operating in 15 states.
In these roles, Jim guided both companies through a variety of regulatory processes at both the state and national levels. Jim lead the legal efforts to expand Molina’s Medicaid managed care and Healthcare Exchange business lines into numerous states, as well as Arcadian’s Medicare Advantage business in all 15 states. Jim effectively developed and implemented Corrective Action Plans when faced with CMS sanctions, and has successfully fended-off Department of Justice concerns over antitrust violations. Along the way, Jim obtained many new state licenses for both managed care entities; became an expert on interpreting and implementing the Affordable Care Act (Obama Care) regarding Healthcare Exchanges, Medicaid expansion, and Medicare Advantage plans; and has gained a wealth of knowledge and experience regarding regulatory compliance for government programs, RFP response and bid protests. Jim understands the legal complexities of government sponsored health programs from the government contract, to payor and provider relations, to member and provider disputes.
Jim also brings a practical business perspective to his legal advice and counsel, having served as the Chief Operating Officer for Molina Healthcare of California. As COO of the California plan, Jim lead the development and growth of the plan’s infrastructure, including the development of a robust provider network, regulatory approval of Molina’s Dual Demonstration project, entry into the California Exchange (Marketplace), and Medicaid expansion. His time as COO was Molina Healthcare of California’s most profitable period in its history.
Jim’s legal knowledge and proven track record is invaluable to his health plan and managed care clients. Jim’s clients repeatedly rely on his experience and know-how to assist them as they maneuver through the legal and regulatory issues unique to managed care entities.