Health Care Administrative Law & Regulatory Appeals

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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.

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