Matters
- Representation of regional and national health care providers, including hospitals, health care systems, skilled nursing facilities and ancillary providers, in a range of matters related to Medicare reimbursement disputes before Medicare administrative contractors, state Medicaid agencies and the centers for Medicare and Medicaid Services (CMS) including billing and coding audits, government investigations, and other compliance matters.
- Representation of health care providers at all stages of False Claims Act litigation, OIG/DOJ investigations, commercial disputes between health care providers, defense of audits, civil fraud investigations and appeals before state and federal administrative bodies.
- Served as outside litigation counsel for several Georgia health systems, and in that capacity conducted numerous internal investigations related to physician services, protected health information disclosures and overpayments.
- Brought multiple actions on behalf of hospitals and other providers in arbitration and state and federal court litigation against Medicaid managed care organizations related to underpayments and improper rate changes.
- Defended hospitals in investigation from state Medicaid fraud control unit.
- Defended national ambulance company in multiple false claims actions in New York, Florida and Arizona.
- Defended RAC audits and subsequent appeals for multiple regional health systems.
- Defended ZPIC and UPIC audits and subsequent appeals for physician groups, durable medical equipment suppliers, lab companies and hospice providers.
- Defended UPIC audit and subsequent appeals through reconsideration for national sleep and home oxygen company with a $15 million extrapolated demand; successfully overturned extrapolation at reconsideration level.
- Defended ZPIC audit and subsequent appeals through reconsideration for DME with $2 million extrapolated demand; successfully overturned extrapolation at reconsideration level.
- Defended commercial payor audit and subsequent appeals with extrapolated demand; successfully negotiated overturning extrapolation.
- Defended emergency medicine group on 100 percent pre-payment review and audits; successfully negotiated removal from review and overturned audits.
- Defended emergency medicine group’s medical review audits; successfully overturned 100 percent of determinations at ALJ.
- Represented a children's hospital in arbitrating against a major commercial payor for underpayments and improper payment policy.
