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Julia Tamulis counsels a diverse range of clients on complex healthcare regulatory issues, focusing her practice on advising health plans on Medicare Advantage and risk adjustment compliance matters. Julia also provides healthcare regulatory analysis for transactions in the home health, primary care, and health plan sectors.
Drawing on her healthcare regulatory experience, Julia assists with internal compliance reviews and responding to government investigations, including defending companies facing government scrutiny in False Claims Act (FCA) matters. She has represented clients in the medical device, pharmaceutical, long-term care, and imaging sectors, as well as senior healthcare executives, before U.S. Attorneys’ Offices and the Department of Health and Human Services (HHS) Office of Inspector General in FCA, Stark Law, and Anti-Kickback Statute enforcement actions.
Julia Tamulis counsels a diverse range of clients on complex healthcare regulatory issues, focusing her practice on advising health plans on Medicare Advantage and risk adjustment compliance matters. Julia also provides healthcare regulatory analysis for transactions in the home health, primary care, and health plan sectors.
Drawing on her healthcare regulatory experience, Julia assists with internal compliance reviews and responding to government investigations, including defending companies facing government scrutiny in False Claims Act (FCA) matters. She has represented clients in the medical device, pharmaceutical, long-term care, and imaging sectors, as well as senior healthcare executives, before U.S. Attorneys’ Offices and the Department of Health and Human Services (HHS) Office of Inspector General in FCA, Stark Law, and Anti-Kickback Statute enforcement actions.
Julia recognizes the challenges her clients face in adapting to a constantly changing regulatory landscape. Her practice involves:
Medicare Advantage/Managed Care – Providing analysis regarding Medicare Advantage regulatory requirements and compliance strategies, risk adjustment issues, risk-bearing provider groups and vendors, marketing requirements, rulemaking impacting Medicare Advantage, and other areas.
Government Enforcement and Compliance– Defending clients in healthcare fraud enforcement matters through internal investigations and advocacy before government entities; conducting compliance assessments; assisting with day-to-day operational matters and internal audits; and drafting compliance policies.
Contracting, Regulatory and Operational Matters – Advising on complex operational and regulatory matters for healthcare clients, including health plans, home health and primary care providers, and specialty pharmacies, among others.
Medicare Reimbursement Appeals – Filing and arguing appeals before the Office of Medicare Hearings and Appeals and other levels of appeal.
A former attorney-advisor for the Departmental Appeals Board (DAB), the highest level of appeal within HHS, Julia drafted decisions involving Medicare Part A and Part B coverage and reimbursement claims.
Memberships
American Health Law Association (AHLA) — Hospitals and Health Systems Practice Group, Chair (2023-2025), Vice Chair (2018-2022), Leadership Development Program (2015-2016)
Women’s White Collar Defense Association
D.C. Bar Association — Health Law Section, Steering Committee Co-Chair (2016-2018); Health Law Section, Steering Committee (2015-2016); Health Law Section, New Practitioners Planning Committee (2014-2017)
Julia Tamulis counsels a diverse range of clients on complex healthcare regulatory issues, focusing her practice on advising health plans on Medicare Advantage and risk adjustment compliance matters. Julia also provides healthcare regulatory analysis for transactions in the home health, primary care, and health plan sectors.
Drawing on her healthcare regulatory experience, Julia assists with internal compliance reviews and responding to government investigations, including defending companies facing government scrutiny in False Claims Act (FCA) matters. She has represented clients in the medical device, pharmaceutical, long-term care, and imaging sectors, as well as senior healthcare executives, before U.S. Attorneys’ Offices and the Department of Health and Human Services (HHS) Office of Inspector General in FCA, Stark Law, and Anti-Kickback Statute enforcement actions.
Memberships
American Health Law Association (AHLA) — Hospitals and Health Systems Practice Group, Chair (2023-2025), Vice Chair (2018-2022), Leadership Development Program (2015-2016)
Women’s White Collar Defense Association
D.C. Bar Association — Health Law Section, Steering Committee Co-Chair (2016-2018); Health Law Section, Steering Committee (2015-2016); Health Law Section, New Practitioners Planning Committee (2014-2017)
Representation of CenterWell, the nation’s largest provider of home health services and subsidiary of Humana Inc. (NYSE: HUM), in its acquisition of Trilogy Home Healthcare, the largest home health company in Florida and portfolio company of Kinderhook Industries.
Representation of a Medicare Advantage Organization and its wholly-owned provider group in an internal investigation related to allegations of improper coding practices, hostile work environment, and non-compliance with Medicare requirements.
Representation of a national healthcare company in an investigation related to allegations of fraudulent risk adjustment coding practices. Matter involved government disclosure and an analysis of data correction obligations.
Representation of a Medicare Advantage Organization in an investigation related to data-driven coding anomalies and practices detected at a large contracted provider group.
Representation of a Fortune 50 healthcare company in conducting oversight of network provider marketing practices and compliance with Medicare marketing regulations.
Conducted due diligence and regulatory analysis for a Medicare Advantage plan in connection with multiple transactions involving multispecialty physician practice groups, management service organizations (MSOs), and accountable care organizations. (ACOs)
Provided regulatory guidance to a Medicare Advantage plan regarding participation requirements for CMS innovative payment models, including Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs), and Direct Contracting and Primary Care First models.
Developed and implemented compliance protocols, strategies, and data-driven analytics for a Medicare Advantage plan to conduct oversight of network providers’ risk adjustment practices and ensure plan-wide compliance with Medicare regulations.