Experience
Advised a Large Nursing Home Through a Medicare Audit Appeal
Dinsmore advised a large Ohio nursing home through a three stages of a Medicare audit appeal in connection with physical therapy services. Our attorneys represented the client before an administrative law judge and reduced a multi-million dollar Medicare overpayment to less than $15,000.
Certificate of Need Objections on Behalf of a Nursing Home
We advised a nursing home facility and its related entities through their objection to two related Certificate of Need applications filed by another nursing home facility. After the Certificate of Need applications had been filed, we filed objections with the Ohio Department of Health to challenge the merit of the applications, and a hearing was granted. During the course of the administrative hearings, the parties reached a confidential settlement. The hearings were subsequently dismissed.
Claridge House, Inc. v. USDHHS, 795 F. Supp. 1393 (1991)
Filed a complaint for declaratory and injunctive relief against the United States Department of Health and Human Services on behalf of a nursing home. The federal government alleged the nursing home failed to meet Medicare/Medicaid certification criteria, and it wanted to terminate the nursing home’s participation in the federal payment programs. On behalf of the nursing home, I argued the federal law did not permit the termination. The court agreed with the argument, stating the federal regulations were beyond the scope of federal law, and stated that defendants were enjoined from terminating the nursing home from federal payment programs. This was first lawsuit challenging the validity of federal regulations filed in the United States.
Edward Hamilton v. Ohio Department of Health
Three Ohio AIDS patients filed a lawsuit against the director of the Ohio Department of Health (ODH) to prevent enforcement of proposed rules that would arbitrarily deny funding for potentially life-saving medications to Ohio residents infected with HIV or suffering from AIDS-related symptoms. Defendants claimed that ODH failed to follow statutory rule-making process and the proposed rules were unenforceable. Court agreed that public interest would be served by protecting the right of a public hearing, and issued preliminary injunction preventing ODH from implementing new rules pending resolution of the lawsuit.
FHA/HUD Financing under the LEAN Program
Represented Lutheran Social Services of Central Ohio, Inc. and its affiliates in the FHA/HUD financing in the amount of $1,800,000 for a senior housing apartment complex located in Mansfield, Ohio.
Nursing Home Sale
Represented Lutheran Social Services of Central Ohio, Inc. and its affiliates in the sale of a $7,400,000 skilled nursing facility located in Columbus, Ohio.
Property Acquisition and Bond Financing
Represented a regional healthcare provider in the acquisition and bond financing of nine (9) intermediate care facilities located in Cuyahoga County in the amount of $4,800,000.
Represented a home health care company against allegations of fraud and Ohio Medicaid audit, resulting in no fraud or liability
We represented a home health care company when the Ohio Department of Medicaid sought to implement an Ohio Auditor of State’s audit to recover over $700,000 that Medicaid claimed our client was over-reimbursed. During the case, we discovered that the auditor had considered incomplete and inaccurate data to support the claim and extrapolation of overpayment. We worked with the client to carefully and meticulously examine and organize all of the appropriate documents and files to show that the auditor’s records were incomplete and that our client, in fact, had not been overpaid at all. After we exchanged discovery with Medicaid and prepared the case for hearing, Medicaid voluntarily dismissed the case, resulting in zero liability for our client. During the case, our client and three related entities had also been suspended from Ohio Medicaid for a credible allegation of fraud, but our representation resulted in the suspensions being lifted.