Industries & Practices
Medicare, Medicaid & Managed Care
We prevent and solve compliance issues, reimbursement disputes and enrollment issues.
Collaborating with individuals, group practices, all types of suppliers and facility providers, we help our clients enroll, manage claims and appeal determinations, and comply with ever-changing Centers for Medicare & Medicaid Services (CMS) requirements. From contracting and reimbursement to RAC audits and cost report appeals, we continuously monitor developments in administrative proceedings around the country to find advantages for our clients and have litigated appeals at all levels of administrative tribunals, federal district court and federal courts of appeals.
Change of Ownership RAP appeal
Represented a home health agency in its appeal of post-Medicare Change of Ownership Request for Anticipated Payment suspension imposed by the Centers for Medicare and Medicaid Services. Successfull...
MoreStark Law violation defense
Successfully overturned a $10 million overpayment determination in favor of a physician-owned specialty hospital over alleged violations of the Stark Law.
MoreAppeals of RAC denials
Guided multiple hospitals and health systems through the Medicare appeals process for Recovery Audit Contractor (RAC) claim denials and overpayment determinations. This matter involved prepari...
MoreManaged care organization alliance
Represented a managed care organization in its negotiation of a strategic, multi-state alliance with another managed care organization. The firm represented the managed care organization during in-...
MoreManaged care vendor contracting
Assumed responsibility for reviewing and negotiating nearly all of a large managed care organization’s vendor contracts. This rapidly growing managed care organization enters into dozens of n...
MoreCMS meaningful use audits
Advised hospitals responding to meaningful use audits of the Centers for Medicare & Medicaid Services (CMS) electronic health record incentive payment program, which required analyzing complian...
MoreMedicare reimbursement matters
Represent large teaching hospitals and other non-teaching hospitals on Medicare reimbursement matters and cost report appeals, which include appeals of administrative agency decisions and...
MoreProper payment claim methodology
Worked with an operator of long-term acute care hospitals to resolve a dispute with an insurance carrier regarding Medicare and Medicaid plan payments. We identified the source of payment discrepan...
MoreMedicare reimbursement underpayment settlement
Negotiated a settlement of Medicare reimbursement underpayments with the federal government on behalf of two large health systems.
MoreMedicaid service contracts
Trial Counsel for local county boards serving persons with developmental disabilities in defense of an action brought by private providers seeking to eliminate service contracts betw...
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James F. Flynn
Managing Partner
Diane M. Signoracci
Partner
Elisabeth A. Squeglia
Partner