Development of Specialized Medicaid Strategies
HMBR’s representation has spanned several states including the formation of hospital networks for purposes of client contracts with state Medicaid programs; the development of a demonstration project for chronic pediatric patients; and the development of a Medicaid-oriented HMO. We provide general counsel advice to Medicaid managed care organizations with respect to their provider and vendor contracts, and state and federal regulations applicable to the organization.
Our attorneys represent providers in a full range of third-party payment issues and analyze transactions for Medicare Anti-Fraud and Abuse and Stark law to advise clients regarding compliance issues. We advise as to the appropriate governmental agency for self-disclosure of billing issues and have negotiated various settlement arrangements with CMS, OIG and the US Attorney. We have also been involved in drafting and implementing corporate compliance programs for addressing Medicare and Medicaid law and regulations. In a case of first impression, we were retained to represent a health care system that owns an HMO in an HCFA and OIG investigation regarding health screening.