Commercial Payor Disputes and Related Matters

• Successfully represented large hospital system in litigation with managed care organization (MCO) involving out-of-network emergency services.
• Successfully represented hospital systems in disputes with leased/rental networks, involving silent PPO laws
• Successfully represented large hospital system in litigation with jail health payors, resulting in settlement
• Drafted  Managed Care reimbursement provisions in state COPA
• Represented physician group in litigation with Medicaid MCO relating to outpatient treatment

 Government Investigations

• Represented two public hospitals in DOJ investigation involving inpatient coding initiatives. Successfully resolved without criminal liability.
• Represented large Georgia DME supplier in criminal investigation regarding alleged improper coding and billing of DME. Successfully resolved without criminal liability.
• Represented therapy chain provider in dual criminal and civil investigation regarding alleged improper billing of therapy codes. Successfully resolved without criminal liability.
• Represented public hospital in DOJ civil investigation related to ambulance ALS and BLS billings. Successfully resolved.
• Represented behavioral health provider in  civil investigation related to alleged case rate DRG upcoding to MCO in TennCare program. Successfully resolved..
• Represented numerous individual officers in DOJ joint civil and criminal investigations of related healthcare providers for alleged Stark, AKA, and FCA violations. No action taken against officers.