Kelly Knivila

Experience

Kelly is a partner of the firm who represents hospitals, physician groups, managed care organizations, dental care organizations, practice management companies, county mental health departments, federally qualified health centers, behavioral health providers, residential treatment facilities, and a variety of other providers on both contested and advisory matters. Kelly brings her many years as an attorney representing state Medicaid and licensing agencies to bear in assisting clients to avoid and resolve audit/overpayment and licensing disputes with government health care programs. Kelly also advises clients on a variety of other regulatory issues including Medicare "provider-based" billing requirements; the federal self-disclosure laws, Medicaid rate-setting requirements, False Claims Act and civil penalty laws; compliance programs; fraud and abuse investigations; corporate practice of medicine; provider/payer contracting issues; facility licensing and certification; federal anti-kickback safe harbors; and Stark law requirements, including physician recruitment agreements.

From 1989 to 1992, Kelly was associated with the Washington, D.C. law firm of Covington & Burling, where her practice focused on representing state governments in disputes related to health and welfare reimbursement matters. As an associate at Stoel Rives from 1992 to 1994, she gained significant experience representing private companies in a wide variety of business litigation matters. Between 1994 and 2003, Kelly served as an Assistant Attorney General at the Oregon Department of Justice, focusing her practice on regulatory matters, particularly in the areas of Medicaid reimbursement, health care provider licensing and administrative law. During her tenure at the Attorney General's office, Kelly also gained experience in legislative matters and served as one of two Attorney General appointees to the Hearing Officer Panel Oversight Committee.

Representative Work

  • Represented an owner and operator of adult foster homes and a residential treatment home in the settlement of a Medicaid audit with the Oregon Department of Humans Services ("DHS"). After DHS proposed to recoup over $900,000 in payments, we negotiated a settlement in which DHS reduced its payment recovery to $31,000.
  • Represented Medicaid Dental Care Organization in responding to Oregon Department of Human Services' audit of contract compliance and negotiating favorable compliance plan resolution.
  • Represented physicians in successful negotiation of Stark-compliant hospital recruitment agreements.
  • Represented a rural hospital in seven appeals before the Provider Reimbursement Review Board. Successfully negotiated return of all funds totaling almost $3 million that had been recouped by the hospital's fiscal intermediary.
  • Represented a large, multi-state practice management company in successful negotiation with the U.S. Department of Human Services' Office of Inspector General of a corporate integrity agreement resolving False Claims Act allegations.
  • Represented a federally qualified health center in responding to a state audit of its Medicaid billings; assisted with the successful negotiation of a resolution that resulted in a reduction of more than half of the center's overpayment for the audit period.
  • Represented a mental health provider in responding to the state's audit of its Medicaid billings; resolution reduced the provider's overpayment obligation by more than half.
  • Assisted with the representation of a Medicaid Managed Care Organization in responding to a state quality audit of compliance with contract requirements.
  • Represented various physician groups and other providers in investigating and assessing Medicaid and Medicare overpayments and negotiating repayment obligations with the responsible government agencies.

Professional Honors & Activities

  • Member, Board of Trustees, Randall Children's Hospital Foundation
  • Member, Oregon DHS, Office of Payment Accuracy and Recovery, Rule Advisory Committee (2010)
  • Member, American Health Lawyers Association
  • Member, Oregon Health Lawyers Association
  • Member, American Bar Association, Health Law Section
  • Past Vice-Chair, Board of Directors, Southwest Community Health Center
  • Past Chair, 2012; Chair, 2011; Chair-elect, 2010; Treasurer, 2009; Member, 2007-2008, Oregon State Bar, Health Law Section

Presentations

  • Updated Self-Disclosure Protocols, Oregon State Bar, Health Law Section, June 14, 2013
  • "Victim or Volunteer?: Medicaid RACs and the New 'Report and Return' Law," National Organization for State Associations for Children, Oct. 2012
  • "Medicaid Audits and RACs," Oregon Alliance of Children's Programs, Mar. 2012
  • "State Medicaid RAC Audits," Oregon State Bar, Health Law Section, Dec. 2011
  • "Medicaid RACs and Other Bounty Hunters - Strategies for Survival," Oregon Healthcare Financial Management Association (HFMA), Oct. 2011
  • "Medicare and Medicaid Overpayments: Self-Disclosure and Audits," presented to the Oregon Community College Association, Nov. 2009
  • "Government Audits: A Team Sport," presented to the Portland Area Medical Community Managers Association, Sept. 2009
  • "RAC Attack: What You Can Expect," presented to the Oregon Association of Hospitals and Health Systems, Oct. 2008
  • "Medicaid Audits: Defending David Against Goliath," presented to the Oregon Alliance of Children's Programs, Feb. 2008; Oregon Prevention, Education & Recovery Association, Jan. 2008; Oregon Primary Care Association, Aug. 2006
  • "Government Audits and Investigations," Washington and Oregon Medical Group Management Associations, May 2006

Publications

  • "Oregon's Coordinated Care Organizations: Health System Transformation or Managed Care Revisited? (co-author)," Willamette Management Associates Insights, Winter 2013
  • "Oregon Supreme Court Rejects Negligence and UTPA Claims in Identity Theft Case," Health Care Law Alert, Stoel Rives LLP, Feb. 2012
  • "U.S. Supreme Court Sends Medicaid Rate Cut Challenge Back To Ninth Circuit," Health Care Law Alert, Stoel Rives LLP, Feb. 2012
  • "HHS OIG Advises Physicians to Use Caution When Reassigning Medicare Payments," Health Care Law Alert, Stoel Rives LLP, Feb. 2012
  • "Final Rule for Group Practices That Provide Advanced Imaging Services," Health Care Reform Alert, Stoel Rives LLP, Dec. 2010
  • "Ninth Circuit Adopts "Implied False Certification" Theory in False Claims Act Cases," Litigation Law Alert, Stoel Rives LLP, Sept. 2010
  • "Overpayment Liabilities for Medicare and Medicaid Providers, Suppliers and Plans," Health Care Reform Law Alert, Stoel Rives LLP, Apr. 2010
  • "Group Practices Providing Advanced Imaging Services Face New Requirements," Health Care Reform Law Alert, Stoel Rives LLP, Apr. 2010
  • "HIPAA's Breach Notification Obligations Begin September 23, 2009," Health Care Law Alert, Stoel Rives LLP, Sept. 2009
  • "Medicaid 101: Navigating the Labyrinth," Oregon Health News, Sept. 2006

Education

  • Georgetown University Law Center, J.D., 1989, magna cum laude
    Senior Articles Editor, Georgetown Law Journal
    Dean's List – all years
  • Western Oregon State College, B.A., 1986
    Senior Woman of the Year
    Federation of Teachers' Scholarship Award
    Dean's List – all years

Admissions

  • Oregon
  • U.S. District Courts for Oregon and the District of Columbia
  • U.S. Courts of Appeals for the Fourth, Fifth and Ninth Circuits

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