Representation of Medicaid ManagedCoordinated Care Organization in dispute with state Medicaid agency concerning enrollee assignment methodology.

Regularly advise on complex Coordinated Care Organization provider agreements including complex value-based payment arrangements.

Representation of Coordinated Care Organization in dispute with state Medicaid agency over enrollment allocations resulting in successful mediated resolution and agreement over future process.

Representation of Coordinated Care Organization in dispute with the Oregon Health Authority regarding actuarial soundness of rate-setting methodology resulting in mediated resolution.

Advised Regularly advise behavioral health providers regarding applicability of Medicaid exclusion for Institutions for Mental Diseases (IMDs).

Regularly advise behavioral health providers on the applicability of 42 CFR Part 2 including in mixed-use facility organizations.

Representation of county behavioral health program in responding to audit by state Medicaid agency and Medicaid Managed Care Organization.

Representation of Community Mental Health Program in OHA extrapolation audit of mental health and substance use disorder services resulting in settlement resulting in withdrawal of audit in favor of provider self-audit.

Conducted multiple internal investigations of allegations of billing fraud for physician groups, hospitals, mental health providers, and physical therapy provider.

Represented multiple providers in defending against OHA extrapolation audits typically resulting in settlements with significant reductions in amount owed.

Advised multiple providers on state and federal self-disclosure obligations and negotiated favorable resolutions upon self-disclosure.

Assisted federally qualified health center with self-disclosure to Health Resources & Services Administration (HRSA) regarding failure to comply with conflict of interest regulations.

Representation of physician group in self-disclosure of potential Stark Law violations related to physician compensation model.

Representation of hospital in self-disclosure of potential Stark Law violations related to physician leasing arrangements.

Advised Urban Indian Health Program regarding Medicaid and Indian Health Care Improvement Act program protections for Indians, laws and regulations.

Advised federally qualified health center concerning supplemental payment (wrap) filings and regulations.

Assisted community mental health program to appeal OHA contractor’s denial of authorization and level of care determinations. consultation with state Medicaid agency and applicability of 100% FMAP policy

Representation of national retainer medical practice service provider in negotiated resolution of regulatory concerns raised by Oregon Department of Consumer and Business Services.

Representation of health care service contractor related to the Oregon Department of Consumer and Business Services’ investigation into potential violations of Insurance Code financial reporting regulations resulting in successful Global Settlement resolution.

Representation of home health nurses in dispute over ongoing and planned Oregon Health Authority extrapolation audits; agency agreed to withdraw audit plan in favor of education and training.

Representation of child caring agencies in dispute over planned Medicaid rate cuts; successfully stopped the rate reduction and negotiated a resolution increasing provider rates.