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In Brief: A Digest of Healthcare Projects

Client Success
  • Developed Medicare Advantage Contracting Toolkit for healthcare providers that addresses contract key terms, provider reimbursement rate methodologies and utilization review.
  • Advised provider on MA plan relations in Phoenix, Arizona, where MA plan market penetration relative to Medicare fee-for-service is high (60 percent).
  • Serve as primary outside healthcare counsel for a multi-hospital Catholic health system headquartered in Denver, Colorado. We provide the full range of legal services for its Kansas, Colorado and Montana hospitals. We understand the ethical and religious directives for Catholic healthcare services and how that may impact the operations of the health system.
  • Represented four-hospital nonprofit health system headquartered in Omaha, Nebraska and partnered with a university medical center. We provided government relations expertise in securing legislative changes in PPACA to facilitate the completion of a $135 million joint venture in which the health system is a major partner.
  • Developed affiliations between local governmental entities and private hospitals which used the Medicaid Upper Payment Limit (UPL) Systems in Texas and Louisiana and more recently, the Medicaid Waiver program in Texas, to assist those local communities in drawing more Medicaid dollars from the federal government to treat the indigent.
  • Assisted a large for-profit health care system in appealing over $1.4 million in retrospectively denied claims following a Medicaid Integrity Contractor (MIC) audit.
  • Represent children’s hospitals in creating risk-based provider networks as subcontractors with state Medicaid programs. Proper implementation of these networks encompasses a myriad of antitrust, tax, healthcare, patient privacy and insurance regulatory law considerations.
  • Assist acute, psychiatric and children’s hospitals in Texas in reporting under and complying with the Medicaid Disproportionate Share (DSH) Hospital program.
  • Validated comprehensive records retention schedules for a multi-state hospital health system by applying federal and state requirements for records retention and destruction under healthcare, employment, tax, health and safety, environmental, entity governance and other applicable laws.
  • Represented a healthcare system in a complex licensing and compliance issue involving facility, pharmacy and individual provider licenses and certifications including the licensing agencies and DEA/DPS.
  • Developed physician/hospital clinically integrated networks and more recently, accountable care organizations (ACOs) to reduce costs, improve outcomes as well as develop new reimbursement methodologies.