Experience

Managed Care Organization Experience

• Representation of association of health plans related to legislative proposal to establish new Managed Care Organization Medicaid provider tax.
• Representation of Medicaid Managed Care Organization in dispute with state Medicaid agency regarding actuarial soundness of rate-setting methodology.
• Representation of Medicaid Managed Care Organization in dispute with state Medicaid agency concerning enrollee assignment methodology.
• Representation of Medicaid Managed Care Organization in responding to a state quality audit of compliance with contract requirements; successful negotiation of acceptable corrective action plan.
• Representation of Medicaid Dental Care Organization in responding to state Medicaid agency audit of contract compliance; negotiated favorable compliance plan resolution.
• Representation of 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

• Representation of national retainer medical practice service provider in negotiated resolution of regulatory concerns raised by Oregon Department of Consumer and Business Services.
• Representation of multiple children’s behavioral health providers and association in dispute with state Medicaid agency regarding rate-setting methodology.
• Representation of 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.
• Representation of hospital system in dispute with health plan over provider-based billing requirements.
• Advised provider associations regarding state Medicaid agency rate-setting obligations.
• Representation of 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.
• Representation of association of community nurses in negotiation with state Medicaid agency concerning audits; negotiation resulted in decision to withdraw all pending audits.
• Representation of physician group in self-disclosure of potential Stark Law violations related to physician compensation model.
• Representation of hospital in self-disclosure of potential Stark Law violations related to physician leasing arrangements.
• Representation of 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.
• Representation of 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.
• Representation of federally qualified health centers in responding to state audit of Medicaid billings; settlements reached at fraction of original overpayments assessed.
• Representation of 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

• Representation of health care service contractor related to the Oregon Department of Consumer and Business Services’ investigation into potential violations of Insurance Code financial reporting regulations resulting in successful Global Settlement resolution.
• Representation of state Medicaid agency at trial challenging nursing home rate-setting methodology.
• Representation of state Medicaid agency in beneficiary appeal of denial of liver, lung, and heart transplant.
• Representation of state Medicaid agency before the U.S. Department of Human Services Departmental Appeals Board in dispute concerning disallowance of claim for federal financial participation.
• Representation of state Medicaid agency in adult foster home license revocation hearing and related contempt proceeding.
• Representation of state Medicaid agency in defending against proposed decertification of Intermediate Care Facility for Individuals with Intellectual Disabilities.
• Representation of state Medicaid agency in establishing trusteeship over nursing home that was out of compliance with conditions of participation.
• Representation of state Medicaid agency in provider tax legislation negotiation.

Honors & Activities

• Included in The Best Lawyers in America^® (currently: Health Care Law), 2016–2023
• Listed in Oregon Super Lawyers^® (Health Care), 2017–2022
• Named a Portland Business Journal Women of Influence Award Winner, 2020
• Member, American Health Lawyers Association
• Member, American Bar Association, Health Law Section
• Member; Past Chair, 2012; Chair, 2011; Chair-elect, 2010; Treasurer, 2009; Oregon State Bar, Health Law Section
• Past Member, Cascadia Behavioral Healthcare Gala Committee, 2018–2020
• Past Member, Board of Trustees, Randall Children’s Hospital Foundation, 2014–2019
• Member, Oregon DHS, Office of Payment Accuracy and Recovery, Rule Advisory Committee, 2010
• Past Vice Chair, Board of Directors, Southwest Community Health Center

Insights & Presentations

• “New Proposed Part 2 Rules Aim for Greater HIPAA Alignment,” Stoel Rives Health Law Insider^® blog, February 2023
• “CMS Issues Final Rule Authorizing Extrapolation as Part of RADV Audits,” Stoel Rives Health Law Insider^® blog, February 2023
• “Certified Community Behavioral Health Clinics Beware!” Stoel Rives Health Law Insider^® blog, January 2023
• “Oregon’s Health Care Vaccine Mandate,” Stoel Rives LLP webinar, September 2021
• “Views from a health care lawyer: How Oregon doesn’t work for minorities,” Portland Business Journal, July 2020
• “Non-Urgent and Elective Procedures Update: Oregon and Washington Ease Prohibitions,” Stoel Rives’ Health Law Insider^® blog, May 2020
• “HHS Distributes $30 Billion from CARES Act Public Health Emergency Funds,” Stoel Rives’ Health Law Insider^® blog, April 2020
• “Desperate Times, Desperate Measures: Elective Medical Procedures Banned, PPEs at Risk of Confiscation,” Stoel Rives’ Health Law Insider^® blog, April 2020
• “New Oregon Telehealth Rules to Assist Providers with COVID-19 Pandemic Efforts,” Stoel Rives’ Health Law Insider^® blog, March 2020
• “Legal and Compliance Threats in Health Care in Oregon,” 2019 Oregon State of Reform Health Policy Conference, November 2019
• “SAMHSA Amends 42 CFR Part 2, Seeking to Better Align the Regulation with Today’s Health Care Delivery System,” Health Care Law Alert, Stoel Rives LLP, January 2018
• “Medicaid and CCO Update,” Oregon State Bar, Health Law Section, October 2017
• “CMS Issues Final 60-Day Overpayment Rules,” Health Care Law Alert, Stoel Rives LLP, February 2016
• “IMD Exclusion Legal Update,” Oregon Alliance of Children’s Programs, November 2015
• “What’s New in Medicaid Managed Care,” Oregon State Bar, Health Law Section, October 2015
• “Fraud and Abuse Update,” Oregon State Bar, Health Law Section, October 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, October 2012
• “Medicaid Audits and RACs,” Oregon Alliance of Children’s Programs, March 2012
• “Oregon Supreme Court Rejects Negligence and UTPA Claims in Identity Theft Case,” Health Care Law Alert, Stoel Rives LLP, February 2012 
• “U.S. Supreme Court Sends Medicaid Rate Cut Challenge Back To Ninth Circuit,” Health Care Law Alert, Stoel Rives LLP, February 2012 
• “HHS OIG Advises Physicians to Use Caution When Reassigning Medicare Payments,” Health Care Law Alert, Stoel Rives LLP, February 2012 
• “State Medicaid RAC Audits,” Oregon State Bar, Health Law Section, December 2011
• “Medicaid RACs and Other Bounty Hunters - Strategies for Survival,” Oregon Healthcare Financial Management Association (HFMA), October 2011
• “Final Rule for Group Practices That Provide Advanced Imaging Services,” Health Care Reform Alert, Stoel Rives LLP, December 2010 
• “Ninth Circuit Adopts ‘Implied False Certification’ Theory in False Claims Act Cases,” Litigation Law Alert, Stoel Rives LLP, September 2010 
• “Overpayment Liabilities for Medicare and Medicaid Providers, Suppliers and Plans,” Health Care Reform Law Alert, Stoel Rives LLP, April 2010
• “Group Practices Providing Advanced Imaging Services Face New Requirements,” Health Care Reform Law Alert, Stoel Rives LLP, April 2010 
• “Medicare and Medicaid Overpayments: Self-Disclosure and Audits,” presented to the Oregon County Counsel Association, November 2009
• “Government Audits: A Team Sport,” presented to the Portland Area Medical Community Managers Association, September 2009
• “HIPAA’s Breach Notification Obligations Begin September 23, 2009,” Health Care Law Alert, Stoel Rives LLP, September 2009 
• “RAC Attack: What You Can Expect,” presented to the Oregon Association of Hospitals and Health Systems, October 2008
• “Medicaid Audits: Defending David Against Goliath,” presented to the Oregon Alliance of Children’s Programs, February 2008; Oregon Prevention, Education & Recovery Association, Jan. 2008; Oregon Primary Care Association, August 2006
• “Medicaid 101: Navigating the Labyrinth,” Oregon Health News, September 2006
• “Government Audits and Investigations,” Washington and Oregon Medical Group Management Associations, May 2006

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