Source: https://www.hallrender.com/service/national-health-care-litigation/reimbursement-appeals-litigation/
Timestamp: 2019-04-21 10:35:54+00:00

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Hall Render attorneys have an extensive knowledge of governmental health care program reimbursement programs, as well as the complex administrative processes necessary to assist our health care clients with audits and Medicare/Medicaid reimbursement-related appeals.
Represented 493 hospitals in a consolidated administrative proceeding before the Provider Reimbursement Review Board and the United States District Court for the District of Columbia to challenge a change in the manner MACs adjusted the hospitals’ labor-related costs for wage index purposes following a clarification in the 2005 PPS Final Rule. Abington Memorial Hospital, et al. v. Thomas E. Price.
Represent over 450 hospitals in Medicare DSH Dual/SSI Eligible Days litigation challenging CMS’s conflicting, expansive view of “entitlement” to Medicare, not requiring payment of benefits, but opposing view of the same term, requiring payment when including Supplemental Security Income/SSI days in hospitals’ DSH payments. Numerous group appeals were consolidated for purposes of two different PRRB hearings that are now before the U.S. District Court for the District of Columbia. Advocate Christ Medical Center et al v. Price.
Filed cases that springboarded into two separate rounds of negotiations with CMS to settle the Rural Floor Budget Neutrality Adjustment cases directly with CMS, avoiding the need to continue the litigation. These two settlements encompassed more than 1,400 hospitals nationwide and were easily the largest Medicare settlement in history. A Hall Render attorney was a leader in the settlement negotiations with CMS and led the logistical efforts to preserve the appeal rights for those more than 1,400 hospitals. Appleton Medical Center et al v. Sebelius, Tucson Medical Center et al. v. Sebelius.
Represented hospital on Medicaid Audit demanding repayment of over $5 million. Prior to agency hearing filed motion for summary dismissal which resulted in negotiated withdrawal of the audit results and no repayment by the hospital. In the Matter of Alaska Regional Hospital, Medicaid Audit Appeal Through 2000.
Represented hospital on Medicaid Rate Appeals for Fiscal Years 1991-1999. Settlement resulted in $8 million payment to the hospital. In the Matter of Alaska Regional Hospital, Medicaid Rate Appeals 1991-1999.
Represented taxicab dispatch company who processed Medicaid travel vouchers on behalf of taxicab owners and drivers. Alaska MFCU disallowed the fee on the grounds that a five percent charge was due to person using the voucher being a Medicaid recipient. Office of Administrative Hearings reversed, agreeing with Dispatch company that the five percent charge was the same charge applied to every voucher/charge user and therefore not an “administrative cost related to participation in the Medicaid program.” In the Matter of Alaska Yellow Dispatch.
Won summary judgment against the Department of Health and Human Services, reversing the department’s finding that the hospital was required to conduct asset tests before writing down bad debt. Baptist Health v. Sebelius.
Represented hospital in its challenge to the Secretary’s denial of its Medicare reimbursement and adjustment. The court ruled that the hospital had standing to challenge the regulation. Board of Trustees of Knox County Hospital v. Sullivan.
Successfully challenged the Department of Health and Human Services for its denials of reimbursement for medical services to low-income patients under the Prospective Payment System. Clark Regional Medical Center, et al. v. United States Department of Health and Human Services.
Led two separate rounds of negotiations with CMS to settle the Rural Floor Budget Neutrality Adjustment cases directly with CMS, avoiding the need for litigation. These two settlements encompassed more than 1,400 hospitals nationwide and was easily the largest Medicare settlement to date. Rural Floor Budget Neutrality Adjustment.
Conducted hearings before the Provider Reimbursement Review Board in 2015 on behalf of more than 200 hospitals challenging the manner in which the Centers for Medicare & Medicaid Services apply the Medicare Act provisions related to Disproportionate Share Hospital payment adjustments. The combined cases are now pending before the U.S. District Court for the District of Columbia. Disproportionate Share Hospital Payment Adjustments.
Prevailed over the Department of Health and Human Services in a case challenging the department’s calculation of hospitals’ collective wage index. Viahealth of Wayne County, et al. v. Johnson.
Represented hospital before the Provider Reimbursement Review Board, successfully challenging the intermediary’s refusal to apply costs related to the Joint Nursing Education Program as untimely and unreasonable. Rapid City Regional Hospital v. Cahaba Government Benefits Administrator.
Successfully overturned disallowance of bad debt because it had been turned over to a collection agency. St. John Health v. National Government Services.
In re Oak Ridge Treatment Center.
Represented the residential treatment center for children and adolescents before the Ohio Department of Children and Family Services in response to allegations the facility improperly charged Ohio Medicaid for services related to patient medication.

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