Outside Counsel for Pharmacy Benefit Manager and Specialty Pharmacy

Provide regulatory compliance and general corporate representation on behalf of specialty pharmacy and pharmacy benefit manager client.

Advised Medical Equipment Manufacturer in Response to Medicaid Fraud Investigative Subpoena

Directed the manufacturer’s response to an investigative subpoena from the Indiana Attorney General’s Medicaid Fraud Control Unit concerning most-favored nation pricing laws. No charges were filed.

Recovered Medicaid Contract for Home Health Provider

Represented a home health provider in appealing its suspension from Medicaid for allegations of fraud.  The Missouri Medicaid Audit & Compliance Unit rescinded the suspension, paid the provider over $60,000 in backpay, and reinstated the provider’s Medicaid enrollment.

Successfully Appealed 16 CMS Payment Denials

Represented a behavioral health hospital in in requesting reconsideration of 16 payment denials from the Centers for Medicare and Medicaid Services (CMS) for the alleged failure to certify and recertify patient care. All 16 appeals were granted in favor of the hospital by the federal Qualified Independent Contractor, saving the hospital over $150,000.

Negotiated Settlement for Physician's Clinic

Negotiated a settlement for a physician's clinic that reduced MO HealthNet's alleged overpayment by 95 percent.

State Prosecutor Experience

Prosecuted Personal Care Provider in Medicaid Fraud Case

Successfully prosecuted a personal care provider in St. Louis County, Missouri. The defendant pled guilty in July 2018 to one felony count of Medicaid fraud.

Successfully Prosecuted Personal Care Provider in Three-Day Trial

Successfully prosecuted a personal care provider in Jackson County, Missouri. After a three-day trial in June 2018, the jury returned guilty verdicts on all counts; two felony counts of Medicaid Fraud and one felony count of Financial Exploitation of an elderly person.

Won Appeal in Missouri Medicaid Audit and Compliance Unit Case

Won an appeal of a Missouri Medicaid Audit and Compliance Unit (MMAC) provider sanction against a home health and adult day care provider. After a bench trial in Jefferson City, Missouri, the Administrative Hearing Commission upheld MMAC’s suspension of the provider from Medicaid.

Contact Us
  • Worldwide
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Boston, MA
800 Boylston St.
30th Floor
Boston, MA 02199
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Boston, Massachusetts
Denver, CO
4643 S. Ulster St.
Suite 800
Denver, CO 80237
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Denver, Colorado
Dublin, Ireland
Fitzwilliam Hall, Fitzwilliam Place
Dublin 2, Ireland
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Edwardsville, IL
115 N. Second St.
Edwardsville, IL 62025
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Edwardsville, Illinois
Jefferson City, MO
101 E. High St.
First Floor
Jefferson City, MO 65101
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Jefferson City, Missouri
Kansas City, MO
2345 Grand Blvd.
Suite 1500
Kansas City, MO 64108
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Kansas City, Missouri
Las Vegas, NV
1980 Festival Plaza Drive, Suite 750
One Summerlin
Las Vegas, NV 89135
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Las Vegas, Nevada
London, England
Royal College of Surgeons of England
38-43 Lincoln’s Inn Fields
London, WC2A 3PE
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Miami, FL
355 Alhambra Circle
Suite 1250
Coral Gables, FL 33134
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New York, NY
7 Times Square, 44th Floor
New York, NY 10036
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Orange County, CA
19800 MacArthur Boulevard
Suite 300
Irvine, CA 92612
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Philadelphia, PA
2005 Market Street
29th Floor, One Commerce Square
Philadelphia, PA 19103
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Philadelphia, Pennsylvania
Princeton, NJ
100 Overlook Center
Second Floor
Princeton, NJ 08540
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Princeton, New Jersey
Salt Lake City, UT
222 South Main St.
Suite 1830
Salt Lake City, UT 84101
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Salt Lake City, Utah
St. Louis, MO
7700 Forsyth Blvd.
Suite 1800
St. Louis, MO 63105
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St. Louis, Missouri
Washington, D.C.
1050 Connecticut Avenue NW
Suite 500
Washington, DC 20036
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Wilmington, DE
1007 North Market Street
Wilmington, DE 19801
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Wilmington, Delaware