Matters
- Secured favorable Advisory Opinion from the HHS/OIG opining that an arrangement would not create prohibited remuneration under the anti-kickback statute, and would not subject a client to administrative sanctions or exclusion from participation in Medicare and Medicaid
- Advising clients on federal health care program reimbursement and payment issues, including Medicare and Medicaid requirements and limitations
- Assisted in development and CMS approval of Medicaid Supplemental Payment Methodologies for physician payment
- Resolution of Medicaid overpayment investigations without imposition of penalties
- Advised hospital associations regarding development and implementation of supplemental payment program through inter-governmental transfer and use of provider fees in the Medicaid program
- Advising clients on fraud and abuse issues and implications of corporate transactions in a variety of forms including joint ventures with physician and hospital referrals, appropriate billing and cost reporting to Medicare and Medicaid, payments to physicians other than referral sources, and overpayment returns to Medicare and Medicaid
- Resolution of Medicaid Supplemental Payment Options
- Defending clients against allegations of fraud and abuse and submission of false claims
- Negotiation of Corporate Integrity Agreements, engagement of Independent Review Organizations and implementation of CIA compliance and eventual completion
- Settlement of overpayment allegations by commercial health insurers
- Building and maintaining a compliance program for health care provider to avoid prospective violations of fraud and abuse laws and avoid the submission of false claims
- Integration of US Health Care fraud and abuse compliance with Foreign Corrupt Practices Act compliance
- Advise regarding development of and reporting issues regarding Sunshine Physician Payment Reporting requirements for health care manufacturers
- Operational responsibility for Medicaid claims payment totaling nearly $4 billion per year
- Negotiation of $50 million multi-year information technology contract for eligibility determination
- Management of external audit and program integrity contractors
