Medicare and Medicaid Reimbursement

Clark Hill attorneys have extensive experience advising clients on matters of Medicare, Medicaid and third party reimbursement issues. Payment concerns are naturally of the utmost importance to every health care system, medical practice and care provider; Clark Hill is well versed in the many laws and regulations that impact this crucial component of the health care industry.

We work with a wide range of health care clients, from hospital systems to individual providers, assisting them with billing practices, making sure they remain in compliance with government and industry regulations, negotiating favorable settlements and establishing relationships with Medicare, Medicaid and other third party payors. We assist our clients by proactively assessing and helping to prevent potential risk areas such as false claims, fraud and abuse and bad debt collection issues.

Experience

Assisted clients on how to respond to growing demands to make their companies and products more sustainable, a goal increasingly being adopted by companies in the health care industry

Commented on EPA rulemaking s for a trade association representing a segment of in the health care industry 

Tracks regulatory developments for health care industry clients to provide early warning of significant new regulations or risks to a company's business, particularly concerning issues relating to FIFRA compliance for chemicals which claim to reduce Ebola, norovirus, and other viruses that are unlikely to have been explicitly testing in the original pesticide registration process 

Advised on methods of responding to regulatory agency and press concerns about the presence of "toxic" chemicals in products used by the health care industry

With assistance from  Kristi Gauthier,  Ed Hammond, Peter Domas and Bishop Bartoni, Kevin Hendrick and Nicole Tersigni successfully defended an insurance priority dispute, resulting in an extremely favorable judgment for firm client, United States Steel Corporation’s ERISA-governed Retiree Benefits Plan.  U. S. Steel Retirement Plan was joined as a third-party defendant in a pending dispute by a No-Fault Automobile Insurance carrier,  which had been sued by a healthcare service provider for unpaid patient attendant care fees.  The No-Fault Carrier claimed that the obligation to pay for these services under Michigan No-Fault law  fell to U. S. Steel Retirement Plan, which covered the patient (who was a former U. S. Steel employee).  Ed, Bishop, Kristi and Peter lent their expertise to Kevin and Nicole in interpreting alleged conflicting insurance priority provisions and explanations of benefits.  Kevin and Nicole crafted a legal argument that ultimately led to summary disposition in favor of U.S. Steel Plan, and against the No-Fault carrier, saving U.S. Steel Plan from payment of the healthcare fees, and also reimbursing U.S. Steel Plan for benefits it had earlier paid by mistake, out of priority.  As the No-Fault carrier had rejected the Case Evaluation award prior to the filing of cross motions for summary disposition, it also appears that attorney  fees are recoverable for our client.  Kristi and Ed on Employee Benefit law, Bishop on Michigan No-Fault law, and Pete on Health Care issues, proved to be unbeatable resources.

Managed Care and Health Care Industry Litigation - Practiced before state and federal agencies and the courts relating to Medicare and Medicaid reimbursement issues.

Formation of joint ventures among physicians.
Represented major corporation in various acquisition and divestiture transactions involving developing technology.
Represented non-profit hospital in a conversion to for-profit status.
Represented nephrology clinics in a merger into a publicly traded company.
Represented hospital in merger transaction.

Health Care Industry Litigation - Participated and litigated in several federal bankruptcy and state court receivership proceedings of hospitals.

Antitrust and Trade Regulation - Lead Counsel in an antitrust case which successfully put an end to a decade’s long boycott against one of the largest dental insurers in the country.

Managed Care and Health Care Industry Litigation - Counseled clients and litigated third party reimbursement and accounting for reimbursement issues.

Formation of and counsel to medical professional corporations.
Formation of joint ventures between hospitals and physicians.
Representation of medical billing companies.
Representation of medical staffs and hospitals on amendments to medical staff bylaws.
Representation of rehabilitation entities.
Represented parties in sales of medical practices to hospitals and in divestitures of medical practices from hospitals.

Antitrust and Trade Regulation - Reported antitrust decisions include the following: Pennsylvania Dental Association v. Medical Service Association of Pennsylvania, 815 F.2d 270 (3d Cir. 1987), rev’g, 632 F.Supp. 653 (M.D. Pa. 1986), cert denied, 484 U.S. 851 (1987); Pennsylvania Dental Association v. Medical Service Association of Pennsylvania, 745 F.2d 248 (3d Cir. 1984), aff’g, 574 F.Supp. 457 (M.D. Pa. 1983), cert. denied, 471 U.S. 1060 (1985).

Antitrust and Trade Regulation - Antitrust litigation experience includes representing clients in the insurance, health care, soft drink, construction, manufacturing, hardware and building materials industries.

Represented physician parties in corporate split-ups.

Managed Care and Health Care Industry Litigation - Litigated provider participation status under the Medicare program.

Managed Care and Health Care Industry Litigation - Litigated issues related to institutional providers’ Medicaid cost reports.

Counsel to mid-market health care companies including cancer treatment centers, dialysis centers, sleep labs, and ambulatory surgery centers providing lead counsel and coordinating legal counsel on a wide array of matters including corporate matters, operations, acquisition and divestiture transactions, joint venture projects, corporate governance, business planning and financial transactions, and legal compliance.

Represent healthcare insurers, third party administrators, managed care organizations and others in contractual, business and other disputes. Representation includes counseling clients and litigating issues regarding payments, accounting for payments, third party administration and self-insured health plan issues, fraud claims, among others

News
Clark Hill Attorneys to Present at the 2017 MCMCFC Spring Management ConferenceClark Hill Princeton Welcomes Attorney Jeanne StiefelClark Hill Attorney Andrew B. Turk Named Top AZ Business Leader by AZ Business MagazineClark Hill Attorney Gerald “Jud” DeLoss to Present Behavioral Health Managed Contracts Webinar on July 14, 2016Clark Hill Attorney Gerald “Jud” DeLoss to Present at the American Health Lawyers Association Annual Meeting in Denver, CO, on June 28, 2016Clark Hill Attorney Andrew B. Turk Named 2016 Top 100 Lawyers in Arizona by AZ Business MagazineClark Hill Attorney Gerald “Jud” E. DeLoss to Teach Health Data Class at Northwestern University Law School February 4, 2016Clark Hill Attorney Gerald “Jud” E. DeLoss to Present at American Health Lawyers Association Physicians and Hospitals Law Institute on February 8, 2016 in Austin, TXClark Hill Health Care Attorneys to Present “The Economics of Medical Practice Under HIPAA/HITECH” Webinar Sixty-Six Clark Hill Attorneys Selected for the 2015 Super Lawyers Business EditionTwenty-Eight Clark Hill Attorneys Named to DBusiness Magazine's 2016 Top Lawyers ListSixty-Five Clark Hill Attorneys Named to Michigan Super Lawyers 2015 ListClark Hill Attorney Scott D. Braun Presented at Florida Society for Healthcare Risk Management & Patient Safety Annual Meeting August 14, 2015Clark Hill Attorney Gerald “Jud” E. DeLoss to Present at HMFA Webinar on MACRA Legislation Overview on September 15, 2015Clark Hill Attorney Jeremy D. Bowen Co-Authored Chapter in “Physician Law: Evolving Trends & Hot Topics 2015” For the ABA Health Law SectionClark Hill Attorney Gerald “Jud” E. DeLoss to Present in Live Broadcast During American Health Lawyers Association Annual Meeting June 30, 2015Clark Hill Attorneys Gerald “Jud” E. DeLoss and Gregory W. Moore to Present at the American Health Lawyers Association Annual Meeting June 29 – July 1, 2015 in Washington DCClark Hill Attorneys Jason R. Canvasser and Serene K. Zeni Present Webinar to Michigan Association of Neuropathic Physicians June 15, 2015Clark Hill Attorneys Peter J. Domas, Steven K. Girard, and Nicole M. Paterson to Present During the 2015 MCMCFC Annual Spring Management Conference Tuesday, June 2Clark Hill Health Care Practice Group Announces Membership in the Illinois Alcoholism and Drug Dependence Association Veteran Health Care Attorney Gerald ‘”Jud” DeLoss Joins Clark Hill ChicagoClark Hill Attorneys' Article "Managed Care Litigation and the Affordable Care Act" Named to "The Best of ABA Sections"Clark Hill Attorneys Joseph Friedman, Neda M. Ryan, Elizabeth Collura and Jeremy D. Bowen Published in The Health Lawyer Clark Hill Phoenix Continues to Grow with Two New Additions Clark Hill Attorneys Jonathan Boulahanis and Jayme Matchinski Presented “Wage & Health Insurance: What You Need to Know”Clark Hill Attorney Kristi Gauthier will Present on Wellness Program Compliance for the Arizona Small Business AssociationClark Hill Continues to Grow Phoenix Office with the Addition of Arizona Employee Benefits Attorney Kristi R. GauthierClark Hill Attorney David M. Cessante to present at the 2014 Michigan Health Care Human Resources Conference in East Lansing May 1stClark Hill Attorney Joseph Friedman Participates in AHLA Institute for Health Plan Counsel – April 9, 2014Clark Hill Attorney Reginald M. Turner to Present on Managing Retiree Health Benefits for the Michigan Public Employers Labor Relations Association March 7, 2014Clark Hill Attorneys Gregory W. Moore and Peter J. Domas Presented at the HCCA Managed Care Compliance ConferenceHealth Care Attorney Jayme R. Matchinski Joins Clark Hill ChicagoClark Hill Attorney Kristi Gauthier to Present at MBPA Healthcare Reform Conference September 24, 2013Clark Hill Attorney Kristi Gauthier to Present at Healthcare Reform Seminar September 10, 2013Clark Hill Attorney Joseph Friedman Speaks to Pittsburgh Business Times Regarding Challenges Evident in Highmark /UPMC Rivalry in Light of Implementation of Healthcare ReformClark Hill Attorney Kristi Gauthier to Speak at the MBPA Health Care Conference – April 9Clark Hill Attorneys Grant T. Pecor and Nicole M. Paterson to Present at Health Care Association of Michigan NADONA Annual Convocation & ExpoClark Hill Attorneys Ray J. Koenig III and MacKenzie A. Hyde to Present on “Dealing with Decision-Makers in a Health Care Setting: Identifying Red Flags and Avoiding Pitfalls”Clark Hill PLC Attorney Kristi R. Gauthier to Author a Series of Health Care Reform, Expert Advice Articles for the Michigan Business and Professional AssociationClark Hill PLC Attorney Neda Mirafzali Featured in Ms. JD Article, "Women Lawyers Who Rock: Healthcare Law Attorney Neda Mirafzali"Clark Hill PLC Attorney Kristi R. Gauthier to Present During Crain's Detroit Business Webinar, "Impact of the Affordable Care Act on the Small Business Community"Clark Hill West Michigan Attorneys Grant T. Pecor and Nicole Paterson to Present at Health Care Association of Michigan's Spring Leadership Conference, March 21Clark Hill Attorney Kristi R. Gauthier to Present “Health Care Reform: What Everyone Wants to Know”Clark Hill Attorney Ryan Lorenz to Present at Arizona Society for Healthcare Risk Management on November 12, 2010Clark Hill Attorney Gregory W. Moore to Co-Present “Federal Health Care Reform: What it Means for Michigan Employers” WebinarClark Hill Attorney Gregory W. Moore Featured on Michigan Talk Radio NPRClark Hill PLC Immigration and Health Care Attorneys Present “Life After Training: Options For J-1 And H-1B Physicians” November 14 in TroyClark Hill Attorney Gregory W. Moore to Speak at Southwest Michigan Physician IT Summit “Preparing Your Practice for EMR Adoption”Clark Hill Attorney Kristi R Gauthier Elected to Board of Variety FAR Conservatory of Therapeutic and Performing Arts
Articles
Andrew Turk Named 2017 Top AZ Business Leader by AZ Business MagazineRelationships & the Law Today: Protecting Your Interest in Shared Assets after Blumenthal v. Brewer - Windy City Times, October 19, 2016Relationships & the Law Today: Married on Sunday, Fired on Monday: Recent Developments in Employment Law - September 21, 2016Jud DeLoss Quoted in Alcoholism & Drug Abuse Weekly: Illinois residents with good insurance targeted by Florida provider – June 13, 2016Gerald DeLoss Quoted in "How Electronic Health Records Can Hurt You in Malpractice Suits" By InsureonTop 10 Health Law Issues 2016 by AHLA Connections Health Attorney Gerald DeLoss: Data Sharing, Use Agreements in the Midst of an Evolution (Q&A) in FierceEMR - February 5, 2016Gun safety: HIPAA change allows providers to report on some mentally ill patients No Pharmacist Duty to Monitor Patient Prescription History by Courtney Posnik in IAHA Magazine Overpayments: Key Issues Physicians Should Consider, Legal Matters, The ChicagoDoctor.com - Part 2 of 2Overpayments: Key Issues Physicians Should Consider, Legal Matters, The ChicagoDoctor.com - Part 1 of 2Relationships & Law Today: Healthcare Decision-Making for the LGBTQ Community - August 12, 2015The Hospital Readmission Reduction Program: Fraud and Abuse Concerns - Spring 2015Story Behind 'The SGR Fix' in 900 Words or Less - Healthcare Michigan, May 2015Patient-Physician Confidentiality: 'Til Death Do Us Part?A Crystal Ball: Managed Care Litigation in Light of the Patient Protection and Affordable Care Act, The Health LawyerHealth Care Without Borders in DBusiness, November-December 2014Thinking of Investing In, or Renting Space In, an ASC? Have You Taken Compliance into Consideration?"Not-So-Friendly Competition" in Sleep Review: The Journal for Sleep SpecialistsHow to Legally Break Up With Your PatientHospital Incentives to PhysiciansHospital Incentives to PhysiciansManagement and Third-Party Billing CompaniesManagement and Third-Party Billing Companies Reporting Post-Operative Pain Management Procedures in 2013A Survey of State Prompt Pay Laws, Part IISo You're Thinking of Getting into the Business of Healthcare? Here Are the Top 5 Things You Need to KnowA Survey of State Prompt Pay Laws, Part IWhat You Need to Know About the Supreme Court's Decision on Health Care ReformSocial Media Policies: Do I Really Need One?Five Steps to Protect Your Organization from HIPAA AuditsThe Required Hospital Standard Charge Publication That You Probably Missed, American Health Lawyers Association Hospitals & Health Systems RXAnesthesiologists Should Beware of HIPAA Audits
Presentations
Webinar: The Economics of Medical Practice under HIPAA/HITECHWebinar: Entrepreneurial Medicine: Opportunities to Enhance Your Practice and Bottom LineWebinar: Physician Compensation Reform: How You Will Get PaidA Risk Manager, Claims Manager and Lawyer Walk Into a Bar..Physician Webinar Series
Media
Nursing Home Litigation with Andrew Turk By The Legal Broadcast Network