Jowita J. Walkup

Representative Experience

• Assist hospital system in connection with Medicare and Medicaid managed care organizations and health plans payments.
• Assist hospital system in federal Medicare wage index audit.
• Counsel large health care system regarding direct graduate medical education reimbursement issues and a variety of billing matters, such as documentation requirements for specific services.
• Advocate for hospital clients in Medicare appeals before the US Department of Health and Human Services Provider Reimbursement Review Board in cases involving issues such as graduate medical education and indirect medical education payments, reimbursement for physician services, bad debt reimbursement, disproportionate share hospital payments, and a variety of other cost report audit adjustments.
• Represent large health care system in opposing a State audit of emergency services to undocumented immigrants and in a Department of Justice civil investigation of Medicaid billing practices relating to services to undocumented immigrants.
• Assist large health care system regarding proposed State budget legislation and in connection with complex federal and state statutes and regulations governing supplemental Medicaid payments, such as Disproportionate Share Hospital and Upper Payment Limit payments, to eligible public hospital systems and the funding of such payments through Inter-Governmental Transfers.
• Counsel hospital and large health care systems in preparing responses to audit letter inquiries.
• Counsel large health care system and hospital association regarding Medicare indirect medical education payments for services provided to Medicare managed care inpatients when managed care organizations deny payments, and regarding related direct graduate medical education cost reporting implications.
• Represent large health care system in federal court action against the Secretary of the US Department of Health and Human Services, challenging a Centers for Medicare & Medicaid Services Administrator’s reversal of a favorable Provider Reimbursement Review Board decision and alleging that the federal Medicare agency applied an illegal and arbitrary cap on reimbursement in violation of the Medicare Act and Administrative Procedure Act.
• Counsel large health care system in various matters, including assistance regarding prosecution of Medicare appeals, supplemental Medicaid payments, opposing government audits, creation and implementation of a compliance program, and defense in suspected Medicare/Medicaid fraud investigations.
• Represent academic medical center in challenging a New York State Office of the Medicaid Inspector General Audit of Article 16 clinic services furnished to individuals with developmental disabilities.
• Represent large health care system and a hospital in negotiating US Department of Health and Human Services settlements of the clients’ Provider Reimbursement Review Board appeals involving challenges to the rural floor budget neutrality calculation.