Medicaid Reimbursement Strategies

Representative Experience

• 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.