Health Care Provider Practice

2012 - Recovery of Medicare Underpayments

When Grady Memorial Hospital was getting less than its fair share of federal funding for Medicare, they turned to Charles Johnson and Paul Vranicar in the Atlanta office of Holland & Knight. As a result of an intermediary's interpretation of Medicare regulations, Grady had been underpaid by approximately $4 million from 2003-2004. The Atlanta team quickly pushed two cases that had been pending for years to hearings before the Provider Reimbursement Review Board in Baltimore. At the last moment before each hearing, the intermediary agreed to reimburse Grady for almost the full amount owed.

Grady Memorial Hospital is the primary hospital for inner-city and medically indigent populations in DeKalb and Fulton Counties - the two largest counties in the Atlanta metro area. Grady Memorial Hospital serves as the only Level-1 trauma center in metro Atlanta and for 100 miles in all directions. It also serves as one of only two burn units in the state, provides ambulance coverage for the city of the Atlanta, houses the state's Poison Control Center, and serves as a regional referral for high-risk obstetrics and neonatal care.

2009- Medicaid Outpatient Settlements

In 2009, the Holland & Knight team won a number of cases in which the courts ordered the State of Georgia to follow its own rules in reimbursement for outpatient services, resulting in supplemental payments to the Grady for the following years in the following amounts:
 

Hughes Spalding FY 1999-2002: $1,826,333.00

Grady Memorial Hospital FY 2000: $1,543,074.00

Grady Memorial Hospital FY 2001: $2,230,246.00

Total: $5,599,653.00

2008 - Rare Grant of Rehearing on Medicaid Reimbursement

With Holland & Knight's help, a large public hospital in Atlanta finally obtains $1.8 million in reimbursements.

Charles Johnson, Sarah Leopold and Josh Bosin (all ATL) recently received an appellate win on behalf of Grady Health Systems. The case stems from an action by the Georgia Department of Community Health (DCH) to under-reimburse Hughes Spalding for services rendered to Medicaid patients from 1999-2002.

Hughes Spalding was owned and operated by the Fulton-DeKalb Hospital Authority (d/b/a Grady Health System). The DCH based its reimbursement decision on a retroactive application of its hospital services manual, despite the existence of a contract between the parties expressly prohibiting such retroactive action. The action by the DCH resulted in a $1.8 million loss to Grady.

Grady's in-house counsel first challenged the action in administrative proceedings and lost before an administrative law judge who affirmed DCH's reimbursement decision. Holland & Knight came in as appellate counsel and successfully appealed the action to the Superior Court of Fulton County. The superior court reversed the administrative law judge and awarded Grady $1.8 million.

On DCH's discretionary appeal to the Georgia Court of Appeals, the court reversed the superior court, adopting the position of the administrative law judge and finding in favor of DCH. Holland and Knight filed a motion for reconsideration arguing that the court ignored the binding authority of the contract between the parties. On Nov. 7, the same appellate panel reversed itself, vacated its original opinion and found in the client's favor based on the arguments advanced in the motion for reconsideration

"Getting rehearing granted like this is an extremely rare occurrence," said Laurie Webb Daniel (ATL), chair of Holland & Knight's appellate team. "This win will provide Grady with a much-needed $1.8 million in reimbursements."

2007 - Atlanta Team wins $1.8 Million for Hughes Spalding Children's Hospital

This is the second time in two years that Holland & Knight has secured a money judgment against the state of Georgia on behalf of Grady Health System.

A Holland & Knight team recently handled an appeal to the Superior Court involving the Georgia Department of Community Health's decision to recoup $1.8 million in Medicaid funds for costs incurred at Hughes Spalding Children's Hospital from 1999 - 2002. The hospital is owned by Grady Health System, Georgia's largest public health system.

The Medicaid plan incorporates Medicare rules which require the regulator to recognize an individual hospital's method of cost allocation. In 2003, the state decided that it would recognize only its own method of cost allocation, and attempted to apply this decision retroactively to Hughes Spalding's cost reports for 1999-2002. The Superior Court of Fulton County sided with Holland & Knight, agreeing that it was improper for the state to engage in this sort of retroactive decision making.

"The Georgia Department of Community Health has essentially acted as if they could run the Medicaid program in any way they like," Charles Johnson (ATL) said. "We have repeatedly been forced to take them to court to establish that they have to follow their own rules and also abide by principles of due process."

The Holland & Knight team was led by Charles Johnson with the assistance of Joshua Bosin, Sarah Leopold, and Jane Warring (all ATL). If the court's decision holds, Grady will receive a refund of the $1.8 million they paid the state some time ago.

2005 - Recovery of Diverted DSH Funds

In 2005, the Atlanta Team secured a $6.4 million judgment for Grady as a result of the state's failure to follow another portion of its Medicaid rules relating to the State’s administration of the Medicaid Disproportionate Share Hospital Program.