Performance & Success
Our Firm has an impressive record of assisting facilities with Medicare and Medicaid reimbursement issues and also defending them when faced with a Medicare Fraud Audit or Medicaid Fraud Audit. Over the past five years, Financial Consultants of Alaska &Washington has reversed $26 million of proposed take-backs and penalties demanded by Medicare and Medicaid on behalf of our facilities. Recently our firm overturned $6,000,000 on a fraud audit on an acute care facility.
Our firm has been successful with many large appeals won at the Supreme Court, or superior Court Level.
Below is a list of some of our appeals:
Unidentified Hospital v. Centers for Medicare and Medicaid Services, Region 10
Federal District Court for the District of Alaska
Case No. 3:04-CV-00152 JWS
Case Summary: Summary Judgment in favor of Hospital invalidating CMS Region 10 approval of portions of a State Plan Amendment. Settlement $225,000.
Nov. 2006
Unidentified Hospital the Matter of, Appeal of Medicaid Provider Fraud Audit
Before the Commissioner of the Department of Health & Social Services
Case No. HS-201-P
Case Summary: Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $6,000,000.
Jan. 2006
Unidentified Hospital V. Alaska Department of Health &Social Services
Superior Court for the State of Alaska, Third Judicial District at Anchorage
Case No. 3AN-01-07103
Case Summary: Successful appeal of a Final Decision of the Commissioner of the Department of Health & Social Services requiring agency to recalculate useful life of hospital assets and reallocate purchase price of three facility buildings. Impact $2,000,000.
Jan. 2003
Unidentified Hospital In the Matter of, Appeal of Medicaid Provider Fraud Audit
Before the Commissioner of the Department of Health & Social Services
Case Summary: Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $4,000,000
2004
Unidentified Hospital In the Matter of, Appeal of Medicaid Provider Fraud Audit
Before the Commissioner of the Department of Health & Social Services
Case Summary: Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $1,500,000
2006
Unidentified Hospital In the Matter of, Appeal of CMS Provider Fraud Audit
Before the Office of the inspector General
Case Summary: Successful challenge to Medicare Fraud Audit resulting in complete withdrawal of demand for repayment of over $4,000,000
2003
Unidentified Hospital In the Matter of, Appeal of CMS Provider Fraud Audit
Before the Office of the inspector General
Case Summary: Successful challenge to Medicare Fraud Audit resulting in complete withdrawal of demand for repayment of over $3,000,000
2002
Unidentified Hospital In the Matter of Medicaid Rate Appeal for FY 1991-1993
Before the Commissioner of the Department of Health & Social Services
Case No. 93-MRC-06
Case Summary: Appeal of numerous reimbursement issues. Case resulted in the single largest Medicaid settlement payment to a health care provider in the history of the Alaska Medicaid Program. $8,000,000
Alaska Department of Health and Social Services v. Alaska State Hospital and Nursing Home Association
Supreme Court of the State of Alaska
856 P.2d 755 (Alaska 1993)
Case Summary: Successful Boren Amendment challenge to the overall Medicaid rate setting methodology. $9,000,000
Unidentified Hospital and General Hospital v. State of Alaska, Medicaid Rate Commission
Supreme Court of the State of Alaska
789 P.2d 360 (Alaska 1990)
Case Summary: First successful challenge to State Medicaid Program Medicaid audit procedures. $2,000,000
Upper Limit Law Suit State of Alaska v. All Nursing Homes in the State of Alaska
Supreme Court of the State of Alaska
Written up in Modern Health Care $15,000,000
Case Summary: All nursing homes in the State of Alaska challenged the State Medicaid program for Routine cost limits imposed
1991
Unidentified Community Mental Health Center v. Medicaid Fraud Unit
Case Summary: Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $850,000
2007
Unidentified Federally qualified Health clinic v. Medicaid Fraud Unit
Case Summary: Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $100,000
2007
YEC law Suit State of Alaska v. Hospital
Superior court of the State of Alaska
Case Summary: Successful law suit in superior Court on Year-end-Conformance penalties $1,000,000
2006
Hospital v. State of Alaska Medicaid Rate Commission
Case no. 3AN-90-6552
Civil Case summary: Decision reversed the final decision of the DHSS, Commissioner and issued a favor decision in favor of the Hospital. $3,000,000
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