Medicaid Appeal—$95 Million Recovery
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.
Standardized Amount Appeal
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.
Graduate Medical Education
Obtained multi-year addition to teaching hospital's Graduate Medical Education cap and Medicare reimbursement through appeal to the PRRB.
Medicare Appeal—$33.5 Million Recovery
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.
Medicare Appeal—$27 Million Recovery
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 clients recovering approximately $27 million.
Medicare Appeal—$6 Million Recovery
Represented a large hospital before the PRRB covering four fiscal years, resulting in over $6 million of additional Medicare reimbursement to the hospital.
State Medicaid Audits
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.
Worked with a physician practice in an alleged overpayment of over $400,000, resolving the matter with a payment of only $30,000.
Investigated and reported a Medicare overpayment to the Centers for Medicare & Medicaid Services (CMS) on behalf of a federally qualified health center.
Reasonable Cost Reimbursement
Persuaded CMS to agree that a certain type of allied health residency program met the Medicare criteria for "reasonable cost" reimbursement.
Advised health systems on coping with evolving Medicare payment rules and maximizing payments through organizational strategies and where necessary.
Conducted internal investigation into causes and extent of billing and documentation errors by hospital personnel for Medicare short-stay admissions.