Tell us about your practice.
I prepare, file and argue appeals of Medicare reimbursement denials on behalf of hospitals. Recently, I have assisted hospitals in preparing for participation in CMS’ settlement program designed to alleviate the tremendous backlog of Medicare appeals, particularly at the ALJ level. Additionally, as part of the firm’s healthcare fraud task force, I assist with the process of responding to government healthcare fraud investigations and provide related healthcare regulatory analysis.
What are some trends you are seeing related to the legal industry or in the industry in which you practice?
In the Medicare appeals space, providers are struggling with the practical implications of the massive delays in the appeals system in terms of employee resources and finances. In anticipation of the October 31, 2014 deadline for hospitals with appeals of inpatient status claims to settle with CMS, hospitals are analyzing the volume, strength, and value of such claims against the benefits of settlement. In the healthcare fraud area, the government’s recent actions and pronouncements indicate an increased use of non-monetary enforcement tactics, including robust corporate integrity agreements, to encourage industry compliance.
How did your work at HHS prepare you for the work you currently are doing?
While at HHS, I drafted decisions in Medicare appeals under Medicare Part A and B for the Medicare Operations Division of the Departmental Appeals Board, the highest level of administrative review within HHS. This experience gave me a solid introduction to Medicare, requiring me to spend most of my time immersed in the Medicare regulations. Beyond developing my writing skills, my time at HHS afforded me an opportunity to spend all of my working time analyzing healthcare regulations and applying them to different fact scenarios, which has proved an excellent background to both my appeals work and my healthcare fraud investigation work.