Health care lawyers Arnold Menchel, Amy de Lannoy and Gregory Gagne helped the following clients successfully challenge recent government health care audits:

• A Connecticut-based medical pediatric practice: following a Connecticut Department of Social Services audit, DSS issued a draft audit proposing to recoup $1,504,860 from the board-certified pediatrician’s office. Through Halloran Sage’s representation, the matter was resolved on very favorable terms, and the recoupment was substantially reduced to $67,773, or 4.5% of the original demand.
• A large Connecticut hospital and regional referral center: represented the client on a Medicaid audit matter that was resolved on very favorable terms.
• A Connecticut hospital: represented the client on a Medicaid audit matter that was resolved on very favorable terms.
• A teaching hospital: represented the client in its appeal of disallowances that were made by the Department of Social Services in an audit of Medicaid Disproportionate Share payments. We brought both an administrative appeal of the DSS decision and a lawsuit in U.S. District Court in Connecticut against the United States Department of Health and Human Services and the Connecticut Department of Social Services, and settled with the client receiving the full amount of $1.3 million back. Partner Joseph Fortner, co-chair of the Firm’s Commercial Litigation Practice Group, and Amy de Lannoy of the Health Care Practice Group assisted in the resolution of this matter.
• A full service eye care practice in Connecticut: represented in connection with an audit initiated by the Connecticut Department of Social Services (“DSS”). We achieved a very favorable settlement on behalf of our client, reducing their liability to DSS by 85%. Associate Breana Vessichio assisted in the resolution of this matter.
• A solo primary care practice: represented in connection with a Medicaid audit. Issues involved billing of injectable medications, billing of psychiatric services and other complex issues. The matter was settled on favorable terms.
• A short term acute care regional hospital: during a Medicaid audit, we met with the hospital personnel, sorted out the issues, attended the Exit Conference and filed an appeal and detailed statement of items of aggrievement. The matter settled with a very positive outcome of the client paying less than 30 cents on the dollar.

Arnold Menchel represents all types of health care providers—including hospitals and long-term care facilities—regarding reimbursement rate appeals, and represents all types of providers regarding Medicaid and Medicare audits and fraud and abuse investigations.

Amy de Lannoy represents numerous clients in Medicaid audits and integrity reviews with the Connecticut Department of Social Services.

Gregory Gagne represents a range of medical institutions on rate-setting appeals, and professionals—Including physicians, dental practices, mental health facilities and physical and occupational therapy practices—in state and federal investigations.

Halloran Sage attorneys understand the highly specialized and focused counsel necessary to serve clients in the health care industry. We are experienced in a variety of disciplines, including:

• Government Regulation
  • Medicaid, Medicare, and HIPAA
• Reimbursement
  • Negotiating Rates of Payments
  • Resolving Disputes with Medicare, Medicaid and Commercial Payors
  • Responding Appropriately to Audits
• Compliance
  • Medicare and Medicaid Regulations
  • HIPAA
  • Corporate Compliance

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