1992 – 2014 Provider-Side Representation Exclusively Limited to Health & Long Term Care
- Representation of institutional providers in audits, investigations, and rate litigation matters.
- Representation of providers in compliance matters, internal investigations and external audits/self disclosure reviews.
- Management of complex litigation/internal reviews/counseling; examples include school-based Medicaid in Education programs; county and statewide cost recovery projects; OMH/OASAS/OPWDD reviews; TPL reimbursement litigation; federal/state criminal investigations and false claims matters.
- General Counsel to long term institutions.
1984 – 1992 New York State Medicaid Agency
- Represented Medicaid audit staff in overpayment and fraud investigations.
- Represented agency in civil rights defense litigation, contempt matters and bankruptcy proceedings in conjunction with Attorney General’s staff; developed legal analysis and strategy ultimately adopted by the Federal courts in provider terminations, disenrollment and withholding of payments.
- Coordinated fraud and recovery efforts with the Attorney General’s Medicaid Fraud Control Unit and US Attorney’s Office.
- Coordinated litigation against the Federal Department of Health and Human Services to enforce Medicare Maximization Project.
- Conducted training of in-house attorneys on hearings and overpayment collection procedures; Developed internal training guides and overviews for audit procedures and litigation support.
- Developed legal standards for settlements and filing of judgments.
- Drafted law and regulations involving exclusion of providers, overpayment recoveries and financial security.
- Developed of legal and financial analysis to support State-wide Medicaid audits and reviews for all provider types within the largest single payor system in the country – NYS Medicaid.
- Obtained precedent setting injunction preventing MFCU from prosecuting non-profit home care agency in false claims investigation. Secured dismissal of indictments.
- Obtained precedent setting order allowing presence of corporate counsel in Attorney General depositions of management employees under Executive Law §63.13 investigation.
- Represented external auditor appointed by the court to review target of false claims action in Brooklyn Adult Day Health Care Program litigation – ultimately resolved by guilty plea and $25 million in restitution.
- Obtained precedent setting order invalidating LTC survey findings in Niagara County Supreme Court and obtained decision overturning CMS substantial compliance in immediate jeopardy situation before the Federal Departmental Appeals Board.
- Resolved numerous audits conducted by MFCU’s Special Projects Unit involving cost audits of CHHAs, LTHHCPs as well as other focused reviews organized by the MFCU and OMIG.
- Resolved numerous rate appeals and rate litigation matters involving all aspects of capital and operating rate deficiencies.