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Overview
A Departmental Appeals Board (DAB) appeal of Centers for Medicare and Medicaid Services (CMS) penalties can be daunting and resource-intensive for many health care providers, particularly skilled nursing facilities. But, a DAB appeal can sometimes be the right strategy to challenge survey-related penalties. Dykema health care lawyers and administrative litigators have the requisite experience, knowledge, and proven track record of success to determine when a DAB appeal has potential merit and to help clients achieve positive outcomes through strategic use of the DAB process.
Our Administrative Law and Regulatory Appeals team will:
- Assess the likelihood of a successful DAB outcome and whether that outcome is best pursued through settlement or full litigation.
- Devise a project plan to manage tasks in an efficient, cost-effective manner and using client in-house resources when possible.
- Use case strategies and legal arguments that have proven successful for clients in other DAB cases.
- Draw on our experience with Medicare participation requirements for various provider categories to develop targeted legal arguments and to present factual and expert evidence in a manner most likely to be persuasive to the DAB.
- Reassess the effectiveness of the project plan and case strategy at key milestones, implementing exit strategies if targeted objectives may no longer be achievable.
Experience Matters
Dykema’s strategies and tactics in handling DAB appeals have produced significant gains for our clients by reducing or eliminating the financial effects of a denial of payment for new admissions penalty, civil money penalty, or even termination from the Medicare/Medicaid program. However, health care providers—particularly skilled nursing facilities—may be involved in a host of other administrative litigation matters. Complaint investigation appeals, state licensure sanctions, Medicare and Medicaid reimbursement appeals, civil rights and HIPAA investigations and appeals, and OIG sanction hearings are serious matters that deserve seasoned attorneys with expertise in both administrative law and health care law. Our experienced professionals represent clients on these important matters, including proceedings with the following agencies:
- U.S. Department of Health and Human Services, Departmental Appeals Board
- U.S. Department of Health and Human Services, Office of Medicare Appeals
- U.S. Department of Health and Human Services, Office for Civil Rights (OCR)
- U.S. Department of Health and Human Services, Office of Inspector General (OIG)
- Michigan Department of Licensing and Regulatory Affairs
- Michigan Administrative Tribunal
- Michigan Department of Community Health and Department of Human Services
At Dykema, we manage administrative appeals and hearings for positive outcomes and, most importantly, results that can help your bottom line.
News
- December 1, 2018
- August 23, 2018
- February 16, 2014
- January 15, 2014
- September 23, 2013
- August 30, 2013
- August 2, 2013
- July 9, 2013
- May 16, 2013
- May 15, 2013
- March 6, 2013
Press Releases
- June 3, 2019
- February 5, 2018
- January 9, 2013
Events & Speaking Engagements
- January 24, 2019
- SNF Regulatory Day: OIG Report on Compliance with Federal Regulations for Reporting Allegations of Abuse or NeglectSeptember 17, 2014
- Moving Forward on Accountable Care System, Panel Participant, LeadingAge Michigan Annual Leadership InstituteAugust 2014
- Federal Regulatory Update: HIPAA/HITECH & More, DSO ConferenceMay 15, 2014
- Federal Regulatory Health Care Regulatory Update, Institute for Continuing Legal Education, Annual Health Law InstituteMarch, 2014-2010
- Federal Regulatory Hot Topics, Healthcare Financial Management Association, Michigan Fall Conference2014-2010
- Peer Review Confidentiality – How to Get It. How to Keep It., Michigan Association of Medical Staff Services Annual MeetingMay 2014
- Compliance Issues in Corporate Transactions, Healthcare Financial Management AssociationApril 11, 2014
- Laws and Regulations that Shape the Health Care System, Oakwood Physician Leadership AcademyMarch 2014 and August 2012
- HIPAA/HITECH Update for Physician Practices, United Physicians, 2014 Winter Leadership Meeting, Pontiac, Michigan, February 4, 2014; and 2013 Office Manager Meeting, Bloomfield Hills, Michigan, December 3, 2013
- Stark Law Update, Key Compliance Issues for 2014January 23, 2014
- HIPAA: Complaints, Investigations, Audits (and Other Things That Go Bump In The Night), Health Care Financial Management Association, 2014 Key Compliance Issues, Bloomfield Hills, MichiganJanuary 23, 2014
- ZPIC Audits – What You Need to Know in 2013, Michigan Association of CPAs Annual Health Care ConferenceApril 2013
- Clinical Integration: A Vehicle for Hospital Benefits to Physicians? Key Compliance Issues for 2013January 24, 2013 and March 12, 2013
- Stark, Plante Moran Healthcare SymposiumOctober 2012
- Medicare Hot Topics: 3 Day Payment Window and Services Furnished Under Arrangements, State Bar of Michigan Health Care Law Section Annual MeetingSeptember 2012
- What Is and Isn’t Your Hospital?, Key Compliance Issues for 2012January 19, 2012 and March 28, 2012
- Healthcare Regulatory Update . . . Are You in Compliance, Michigan Association of CPAs, Annual Health Care ConferenceApril 2011
- Compliance Risks Now That You’ve Bought the Physician Practice, Key Compliance Issues for 2011January 13, 2011
- Regulatory Update, Michigan Association of Medical Staff Services, Annual MeetingApril 2010