Handling Medicare and Medicaid Overpayments: Provider Refund and Reporting Obligations, Avoiding Penalties

Ms. Gordon’s practice is focused on managed care litigation, fraud and abuse matters, inclusive of False Claims Act litigation, managed care contract review, and compliance advising. She has handled a wide array of reimbursement disputes with both commercial and government payors, for both contracted and non-contracted providers. Such disputes also include challenging and responding to payor audits, recoupment requests, and investigations. Ms. Gordon also frequently handles Medicare appeals and ALJ hearings, Targeted Probe and Education audits, Comprehensive Error Rate Testing denials and appeals, and Uniform Program Integrity audits. She routinely defends providers in healthcare fraud and abuse matters ranging from assistance and strategy with responses to Civil Investigative Demands and subpoenas issued by DOJ, OIG, the Department of Insurance, and other governmental entities, to defending providers in qui tam relator actions, False Claims Act actions, and related actions brought under various state laws such as the Insurance Fraud Prevention Act. She also works closely with clients on managed care contract review and negotiation, as well as compliance advising and internal policy development. Ms. Gordon also has substantial experience in the long-term care space, related to both fraud and abuse matters, as well as citation appeals. She has also regularly handled internal audits and investigations and government agency audits, for a variety of healthcare provider types. Ms. Gordon’s practice comprises both providing effective representation for clients in disputes and providing strategic counsel and guidance concerning regulatory issues and actions. With respect to the former, she has handled dozens of matters through arbitration, mediation, before administrative panels, and in courtroom litigation both at the state and federal level.

Ms. Waltz is a health care partner with Foley & Lardner LLP. Her practice focuses on government investigations, false claims acts, corporate integrity agreements (CIAs), reimbursement strategies, bankruptcy, Medicare and Medicaid compliance counseling, and Medicare/Medicaid overpayments and enrollment disputes. Ms. Waltz is the chair of the firm’s Health Care Practice Group and co-chair of the Health Care & Life Sciences Sector’s Providers of Health Care Services Area of Focus. She is also a member of the Government Enforcement Defense & Investigations and Bankruptcy & Business Reorganizations Practices.