Success Stories

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.

pie chart of impacts

Our firm has been successful with many large appeals won at the Supreme Court, and Superior Court Level.

Below is a list of some of our appeals:


Unidentified Hospital In the Matter of Medicaid Rate Appeal

Before the Commissioner of the Department of Health & Social Services

Case No. 93-MRC-06

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


Appeals and Supreme and Superior Court Cases

Unidentified Hospital / Long Term Care Facility

Impact $3,000,000

Assisted in preparing defense against allegations of fraudulent billing practices. Responded to State Search Warrant and provided expert testimony and guidance to hospital / long-term care facility concerning proper billing procedures for State Medicaid Program Personal Care Attendant (PCA) program. Case resulted in facility being fully cleared of all charges and all charges being dropped prior to trial.


Unidentified Hospital

Impact $4,000,000

Assisted in the preparation of an OIG Self-Disclosure concerning billing irregularities discovered during Chargemaster review. Assisted counsel with materials prepared pursuant to OIG Self-Disclosure protocols case resulted in facility having to pay back funds billed improperly with no additional fines or penalties or corporate integrity agreement being imposed.

Many thousands of claims were deemed duplicate billings by the fraud auditor.

We did not find one duplicate claim, and had all of them reversed.

Disallowances for undocumented services:

We were able to locate nearly all records.

One facility had all laboratory documents on the computer rather than in the patient records ?auditors denied Lab charges on every patient audited

We sent all records to the auditors, and eliminated $1 million in disallowances.


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

Summary Judgment in favor of Hospital invalidating CMS Region 10 approval of portions of a State Plan Amendment. Settlement $225,000.


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

Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $6,000,000.


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

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.


Unidentified Hospital In the Matter of, Appeal of Medicaid Provider Fraud Audit

Before the Commissioner of the Department of Health & Social Services

Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $4,000,000


Unidentified Hospital In the Matter of, Appeal of Medicaid Provider Fraud Audit

Before the Commissioner of the Department of Health & Social Services

Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $1,500,000


Unidentified Hospital In the Matter of, Appeal of CMS Provider Fraud Audit

Before the Office of the inspector General

Successful challenge to Medicare Fraud Audit resulting in complete withdrawal of demand for repayment of over $4,000,000


Unidentified Hospital In the Matter of, Appeal of CMS Provider Fraud Audit

Before the Office of the inspector General

Successful challenge to Medicare Fraud Audit resulting in complete withdrawal of demand for repayment of over $3,000,000


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)

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)

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

All nursing homes in the State of Alaska challenged the State Medicaid program for Routine cost limits imposed


Unidentified Community Mental Health Center v. Medicaid Fraud Unit

Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $850,000


Unidentified Federally qualified Health clinic v. Medicaid Fraud Unit

Successful challenge to Medicaid Fraud Audit resulting in complete withdrawal of demand for repayment of over $100,000


YEC law Suit State of Alaska v. Hospital

Superior Court of the State of Alaska

Successful law suit in superior Court on Year-end-Conformance penalties $1,000,000


Hospital v. State of Alaska Medicaid Rate Commission

Case no. 3AN-90-6552

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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