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.
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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