Kevin J. Malone

Overview

Health plans, provider organizations, and government agencies navigating the complex and shifting requirements that govern managed care turn to Kevin Malone for practical, business-minded regulatory counsel shaped by years spent inside the federal agencies that write and enforce those rules.

Kevin is a Strategic Advisor with EBG Advisors and a Member of the Firm in the Health Care and Life Sciences practice at affiliate Epstein Becker Green. His clients range from start-ups and regional health plans to trade associations, state and local governments, and some of the largest health care companies.

In his managed care work, Kevin brings particular depth to issues involving Medicare Advantage, Medicaid managed care, special needs plans, and the Program of All-Inclusive Care for the Elderly (PACE). A substantial part of his practice focuses on delivery systems for Medicare-Medicaid dual-eligible beneficiaries, the federal Mental Health Parity and Addiction Equity Act (MHPAEA), and value-based payment arrangements. He also advises health systems and policy organizations on the regulatory and payer-interface issues that arise under medical aid in dying (MAiD) laws.

Previously, Kevin spent six years in health care financing policy roles at the U.S. Department of Health and Human Services (HHS). He led the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) federal implementation of MHPAEA and, most recently, developed Medicare-Medicaid demonstration models for dual-eligible beneficiaries at the Centers for Medicare & Medicaid Services’ (CMS’s) Federal Coordinated Health Care Office.

Before entering the federal government, Kevin served as a Peace Corps volunteer in Zambia, working in community agricultural development. He later coordinated a national domestic violence prevention program in Zambia before conducting research on community health and social services programs in Washington, DC.

Kevin developed URAC’s Mental Health Parity Accreditation Program, the nation’s first third-party commercial accreditation assessing insurers’ capacity to comply with federal parity law, as well as the industry’s first enterprise software solution for parity compliance. He continues to serve as an accreditation reviewer for the program. He also teaches Managed Care Law and Policy as an adjunct professor at The George Washington University Law School.

What Kevin Delivers for Clients

A Clearer Path Through Regulatory Approval: Kevin’s experience inside HHS and CMS gives clients practical insight into how regulatory review processes work. He helps clients anticipate agency concerns, sequence submissions, and respond effectively to requests, keeping complex applications and approvals moving forward.
Clarity When the Rules Are Still Evolving: When health policy evolves faster than the law, clients often must make decisions before the regulatory landscape is settled. Kevin draws on his experience as a regulator, policy advisor, and outside counsel to help clients assess risk and develop practical approaches in novel and rapidly evolving areas.
Confidence Under Audit and Investigation: Federal and state audits and investigations can demand quick decisions while putting significant pressure on day-to-day operations. Kevin helps managed care organizations and provider entities understand their exposure, respond strategically, and navigate government scrutiny while minimizing operational disruption.
Continuity from the Inside: Some clients need more than outside counsel; they need an advisor who can step into the organization and understand its operations as well as its legal exposure. Kevin’s experience in seconded and acting general counsel roles enables him to provide continuity of judgment during leadership transitions, periods of rapid growth, and other times of change.
Regulatory Support Through the Deal Cycle: Regulatory issues can create uncertainty at any stage of a managed care or value-based transaction. Kevin helps investors and health care companies identify and address those issues before closing and provides ongoing regulatory counsel as businesses integrate, grow, and evolve.