Medicare Appeal—$6 Million Recovery

Advised health systems on coping with evolving Medicare payment rules and maximizing payments through organizational strategies and where necessary.

Investigated and reported a Medicare overpayment to the Centers for Medicare & Medicaid Services (CMS) on behalf of a federally qualified health center.

Engaged by several large health systems to pursue the "standardized amount" appeal on their behalf at the Medicare Provider Reimbursement Review Board (PRRB), either through group appeals where allowed, or through individual appeals.

Obtained multi-year addition to teaching hospital's Graduate Medical Education cap and Medicare reimbursement through appeal to the PRRB.

Developed and prosecuted coordinated Medicaid appeals and litigation on behalf of a group of hospitals that resulted in a landmark settlement of approximately $95 million with the State.

Persuaded CMS to agree that a certain type of allied health residency program met the Medicare criteria for "reasonable cost" reimbursement.

Worked on behalf of two related teaching hospitals in multiple appeals of Medicare disallowances filed before the PRRB covering multiple fiscal years, culminating years of work in a full and complete settlement with our...

Represented group of 19 hospitals in appeals before the PRRB involving over 120 fiscal years, resulting in on-going settlements worth approximately $33.5 million.

Worked with a physician practice in an alleged overpayment of over $400,000, resolving the matter with a payment of only $30,000.

Defended numerous state Medicaid audits alleging substantial overpayments, including a $3.6 million alleged overpayment resolved for $350,000 and a $530,000 alleged overpayment settled for $823, among others.