Experience
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 The Missouri Medicaid Audit & Compliance Unit rescinded the suspension, paid the provider over $60,000 in backpay, and reinstated the provider’s Medicaid enrollment.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.
