Kelly Knivila

Kelly Knivila

Partner
Portland, OR
Overview

About Kelly

Kelly is a healthcare regulatory lawyer who specializes in helping clients solve problems with federal and state regulatory agencies. She has deep experience in the Medicaid program having spent over two decades representing Medicaid Managed Care Organizations, providers and state Medicaid agencies on a wide array of regulatory issues. Kelly also regularly counsels clients on a variety of other healthcare regulatory requirements including Medicare audits and billing requirements, physician self-referral laws (the federal Stark Law and similar state laws), the anti-kickback statute, compliance programs, self-disclosures and internal investigations. 

Prior to joining Stoel Rives, 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. Kelly also spent nine years as an Assistant Attorney General at the Oregon Department of Justice, handling complex regulatory matters, particularly in the areas of Medicaid reimbursement, healthcare provider licensing and administrative law. During her tenure at the Attorney General’s office, Kelly also served as one of two Attorney General appointees to the Hearing Officer Panel Oversight Committee, further augmenting her administrative experience. Kelly is a partner of the firm and member of its Executive Committee.

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Experience

Experience

Managed Care Organization Experience

  • Represented association of health plans related to legislative proposal to establish new Managed Care Organization Medicaid provider tax.
  • Represented Medicaid Managed Care Organization in dispute with state Medicaid agency regarding actuarial soundness of rate-setting methodology.
  • Represented Medicaid Managed Care Organization in dispute with state Medicaid agency concerning enrollee assignment methodology.
  • Represented Medicaid Managed Care Organization in responding to a state quality audit of compliance with contract requirements; successful negotiation of acceptable corrective action plan.
  • Represented Medicaid Dental Care Organization in responding to state Medicaid agency audit of contract compliance; negotiated favorable compliance plan resolution.
  • Represented county behavioral health program in responding to audit by state Medicaid agency and Medicaid Managed Care Organization.
  • Conducted internal investigation of allegations of billing fraud by provider on behalf of Medicaid Managed Care Organization.
  • Obtained approval from the state Medicaid agency for sale of Medicaid Managed Care Organization.
  • Regularly counsels Medicaid Managed Care Organizations concerning various issues including, provider contracting issues, beneficiary appeal and grievances, rate-setting issues, physician incentive plans and compliance programs.

Provider Experience

  • Represented multiple children’s behavioral health providers and association in dispute with state Medicaid agency regarding rate-setting methodology.
  • Represented multiple nonprofit behavioral health providers in the settlement of Medicaid audits.
  • Advised Urban Indian Health Program regarding Medicaid program protections for Indians, consultation with state Medicaid agency and applicability of 100% FMAP policy.
  • Advised behavioral health providers regarding applicability of Medicaid exclusion for Institutions for Mental Diseases (IMDs).
  • Advised federally qualified health centers regarding Health Resources & Services Administration (HRSA) requirements related to governance, affiliation agreements, 340b program requirements, supplemental payments, Federal Tort Claims Act coverage and grant reporting.
  • Represented hospital system in dispute with health plan over provider-based billing requirements.
  • Advised provider associations regarding state Medicaid agency rate-setting obligations.
  • Represented various physician groups and other providers in investigating and assessing Medicaid and Medicare overpayments and negotiating repayment obligations with the responsible government agencies.
  • Conducted multiple internal investigations of allegations of billing fraud for physician groups, hospitals, mental health providers and physical therapy provider.
  • Represented association of community nurses in negotiation with state Medicaid agency concerning audits; negotiation resulted in decision to withdraw all pending audits.
  • Represented physician group in self-disclosure of potential Stark Law violations related to physician compensation model.
  • Represented hospital in self-disclosure of potential Stark Law violations related to physician leasing arrangements.
  • 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.
  • Successfully negotiated early termination of corporate integrity agreement with U.S. Department of Human Services’ Office of Inspector General.
  • Represented federally qualified health centers in responding to state audit of Medicaid billings; settlements reached at fraction of original overpayments assessed.
  • Represented an owner and operator of adult foster homes and a residential treatment home in the settlement of a Medicaid audit; settlement reached at fraction of original overpayment assessed.
  • Regularly advises Medicaid providers concerning contracts with Medicaid Managed Care. Organizations, Medicare and Medicaid billing requirements, compliance programs, Medicaid and Medicare anti-assignment laws, beneficiary inducement law, anti-kickback statute and its safe harbors, and physician self-referral laws (federal Stark Law and similar state laws).

State Agency Experience

  • Represented state Medicaid agency at trial challenging nursing home rate-setting methodology.
  • Represented state Medicaid agency in beneficiary appeal of denial of liver, lung and heart transplant.
  • Represented state Medicaid agency before the U.S. Department of Human Services Departmental Appeals Board in dispute concerning disallowance of claim for federal financial participation.
  • Represented state Medicaid agency in adult foster home license revocation hearing and related contempt proceeding.
  • Represented state Medicaid agency in defending against proposed decertification of Intermediate Care Facility for Individuals with Intellectual Disabilities.
  • Represented state Medicaid agency in establishing trusteeship over nursing home that was out of compliance with conditions of participation.
  • Represented state Medicaid agency in provider tax legislation negotiation.
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Honors

Honors & Activities

  • Included in The Best Lawyers in America© (currently: Health Care Law), 2016-2018
  • Listed in Oregon Super Lawyers® (Health Care), 2017
  • 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 
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Insights & Presentations

Insights & Presentations

  • “IMD Exclusion Legal Update,” Oregon Alliance of Children’s Programs, Nov. 2015
  • “What’s New in Medicaid Managed Care,” Oregon State Bar, Health Law Section, Oct. 2015
  • "Fraud and Abuse Update," Oregon State Bar, Health Law Section, Oct. 2014
  • Oregon chapter (co-author), Corporate Practice of Medicine: A Fifty State Survey, American Health Lawyers Association,  2014 
  • Updated Self-Disclosure Protocols, Oregon State Bar, Health Law Section, June 14, 2013
  • "Oregon's Coordinated Care Organizations: Health System Transformation or Managed Care Revisited? (co-author)," Willamette Management Associates Insights, Winter 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
  • "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 
  • "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
  • "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 
  • "Medicare and Medicaid Overpayments: Self-Disclosure and Audits," presented to the Oregon County Counsel Association, Nov. 2009
  • "Government Audits: A Team Sport," presented to the Portland Area Medical Community Managers Association, Sept. 2009
  • "HIPAA's Breach Notification Obligations Begin September 23, 2009," Health Care Law Alert, Stoel Rives LLP, 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
  • "Medicaid 101: Navigating the Labyrinth," Oregon Health News, Sept. 2006 
  • "Government Audits and Investigations," Washington and Oregon Medical Group Management Associations, May 2006 



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