Margaret A. Donohue

Representative Experience

• Defended provider against government allegations of improperly utilizing diagnosis codes. Earned dismissal with prejudice of primary False Claims Act claim.
• Guided large health care system in formulating and implementing a corporate-wide compliance program, including development of policies, a risk assessment process and internal audit structure. Regularly advise on federal and state compliance requirements.
• Defended large health care system and municipality against alleged manipulation of the Medicaid payment processing system to cause $14 billion of improper payments. Won dismissal with prejudice of entire False Claims Act complaint, which was affirmed by the US Court of Appeals for the Second Circuit.
• Advised high-level reimbursement staff at a health care system on various billing matters, such as documentation requirements for specific services, use of mid-level providers and claim form questions.
• Represented ambulance supplier in settling False Claims Act allegations that it billed Medicare for medically unnecessary emergency transports.
• Defended hospital clients in Medicare appeals before the Department of Health and Human Services Provider Reimbursement Review Board. Cases involve issues such as cost report audit adjustments, graduate medical education payments and bad debt reimbursement.
• Represented large health care system in opposing a State audit of emergency services to undocumented immigrants.
• Represented hospital system in negotiating affiliation agreement with a medical group and related implementation issues.
• Represented academic medical center in challenging a New York State Office of the Medicaid Inspector General audit of Article 16 clinic services to individuals with developmental disabilities.
• Defended health care system against State Medicaid audit concerning behavioral health partial hospitalization services.
• Defended nursing facility in New York State Office of the Medicaid Inspector General audit leading to its ultimate discontinuation.
• Assisted hospital system in responding to various New York State Office of the Medicaid Inspector General audits and reviews. Involves issues such as the Ambulatory Payment Group reimbursement methodology, outpatient services provided during an inpatient stay, billing of drugs provided under the 340B program, and various other documentation concerns.
• Advised large health care system regarding various Medicare, Medicaid and regulatory compliance requirements for home health services.
• Defended hospital and physician group in False Claims Act case. Involves nuanced Medicare/Medicaid reimbursement rules for teaching physicians and residents, podiatry, licensing, and graduate medical education payments.