Resolving Coding Disputes: Analyzing Agreements, Identifying Code Standards, Leveraging Expert Opinions

Mr. Wanerman’s practice concentrates on regulatory, reimbursement, and compliance matters affecting healthcare manufacturers, service providers, and investors in healthcare organizations. He has extensive experience counseling clients in matters arising under the Medicare and Medicaid programs, administrative law and procedure, the False Claims Act, clinical research rules, grant administration rules, the Anti-Kickback and Stark laws, HIPAA, and EMTALA. Mr. Wanerman was formerly an assistant counsel at the U.S. Department of Health and Human Services.

With more than 25 years of experience in healthcare documentation and revenue cycles, Ms. Howard possesses a deep understanding of the intricacies of healthcare coding compliance and documentation. She regularly performs coding, billing and revenue cycle reviews to ensure accuracy and compliance for clients. Working with hospital systems and physician practices of all sizes, these reviews have included evaluation and management, inpatient and outpatient ambulatory services. Additionally, Ms. Howard has worked on corporate integrity agreements and self-disclosure projects, as well as performing as an expert witness in criminal fraud defense.

Ms. MacCarthy has a broad range of litigation and appellate experience. Her work involves the representation of hospitals, physician groups, nursing homes and other licensed health care professionals with regard to health care regulatory issues, ERISA, commercial transactions, labor and employment, insurance, guardianships, medical staff issues and revenue cycle operations, including the management and collection of commercial and patient accounts. Ms. MacCarthy frequently represents hospitals and other healthcare entities in the context of medical staff quality review and corrective action processes, fair hearings and related litigation, assisting these clients to maximize the intended benefit of peer review confidentiality and to achieve state and federal peer review immunity. She also represents healthcare clients in all areas of health law reimbursement, compliance and litigation issues, with a particular emphasis on Medicare and Medicaid reimbursement appeals before state and federal administrative bodies and state and federal courts.

With more than 25 years of regulatory compliance experience, Mr. Zeko leads the firm’s Advisory Services’ Coding Compliance service line. His national practice consists of assisting clients with compliance program assessments, risk assessments, investigations, coding compliance engagements, self-disclosures, physician arrangements reviews, Independent Review Organization (IRO) engagements and Corporate Integrity Agreement- related (CIA) engagements. Mr. Zeko has performed over 70 compliance program assessments and has managed hundreds of coding compliance engagements for public hospitals, academic medical centers, integrated health systems, community hospitals, pediatric hospitals, medical device companies, payors, dialysis providers, physician practices and post-acute care providers. Mr. Zeko and his Coding Compliance team work with external counsel, in-house counsel, compliance departments, revenue cycle management and internal audit departments to investigate, identify and mitigate False Claims Act, Stark Law and Anti-Kickback Statute risks.