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In Brief: A Digest of Medicaid Reimbursement Projects

Client Success
  • Assisted with development and operation of Medicaid upper payment limit (UPL) programs.
  • Performed Medicaid Disproportionate Share Hospital (DSH) analysis, application and payment appeals.
  • Advised healthcare providers on the impact of proposed state legislation, policy initiatives and industry changes, including Medicaid waivers.
  • Represented providers in Medicaid recoupment and audits.
  • Performed internal compliance investigations of suspected Medicaid overpayments.
  • Advised clients on provider donation rules, the Stark law, the federal Anti-Kickback Statute, civil monetary penalties, the False Claims Act and related state laws.
  • Developed Medicaid waiver programs in conjunction with state Medicaid offices and the Centers for Medicare and Medicaid Services (CMS) to more efficiently reimburse Medicaid providers.