N.W., Suite 200
Washington, District Of Columbia 20006
is a partner in King & Spalding’s Healthcare Practice Group. His principal area of practice is in the health industry, and focuses on health care clients, with an emphasis on Medicare coverage, payment, and compliance issues. He represents providers in numerous cases before the Provider Reimbursement Review Board, Administrative Law Judges and the federal courts. He also advises clients on specific compliance questions and has worked with providers in establishing compliance programs. He has been involved in defending a number of cases arising under the False Claims Act.
Dennis Barry's Reimbursement Advisor, monthly newsletter published by Aspen Publishers (editor and principal author), May 1989 - Present
Chapter on cost reimbursement in Health Law Practice Guide, sponsored by the American Health Lawyers Association and published by West Group
Chapter on legal issues arising from relationships between hospitals and physicians in a book sponsored by the ABA Health Law Section, published by BNA in 2002
Past-Chair, AHLA's annual 3-day Institute on Medicare and Medicaid Payment Issues
Member, Board of Directors, American Health Lawyers Association
Past President, Washington Metro chapter, Healthcare Financial Management Association
Representative experience includes:
Prepared a position paper and persuaded CMS officials to issue a policy statement stating that discounts for any uninsured patient without regard to the patient's financial status will not affect Medicare payment.
Obtained decisions from CMS Central Office, CMS Regional Offices and ALJ in five separate instances reversing denials of provider-based status for hospital clinics; in each instance, more than $1 million was in controversy and in one instance, the amount at risk was $19 million a year.
Obtained a favorable administrative resolution of a bed count case for purposes of the Medicare payment adjustment for the costs of indirect medical education for a large teaching hospital client that was worth more than $7 million to the client.
Advised a state medical school on the rules for counting residents rotating to nonhospital sites for purposes of Medicare payments for the direct and indirect costs of medical education, created template agreements and instructions on how to structure rotations and use the agreements to avoid Medicare disallowances at affiliated hospitals.
Successfully litigated bed count case for hospital to qualify for disproportionate share payments as an urban hospital with 100 beds or more that was worth approximately $4 million to the hospital.
On behalf of a children's hospital, convinced HRSA to reverse proposed substantial reductions in the FTE resident count for purposes of CHGME payments for residents assigned to research buildings.
Represented an academic medical center in a qui tam case on Medicare cost reporting fraud allegations in which the government had intervened and negotiated a settlement in the amount of approximately $12 million that was only 20 percent greater than the approximately $10 million in single damages.
Represented a faculty practice plan in a PATH investigation where the Department of Justice declined a referral from the Office of the Inspector General's office for treatment as a False Claims Act matter and subsequently the Office of the Inspector General itself declined to proceed under its civil money penalty authority.
Obtained a decision for a faculty practice plan reversing in its entirety a determination of a Medicare overpayment in the amount of $2.7 million.
Represented a durable medical equipment supplier in challenging an audit from which the results of a sample were extrapolated and relied upon to support recoupment of more than $1.2 million; the carrier fair hearing officer rejected the carrier's statistical methodology in its entirety, and ruled in favor of the supplier on all but $7,000.
Handled a disclosure of extensive fraudulent conduct by a hospital's CEO with no adverse consequences to the hospital except repayment of overpayments.
Drafted a position paper and participated in extensive dialogue with Health Care Financing Administration officials regarding referrals by hospital-compensated physicians to hospital-based home health agencies; HCFA subsequently reversed itself and made such referrals permissible.
Drafted rulemaking comments that convinced HCFA to reverse itself on treating nursing facilities as not having a base year for purposes of the prospective payment rates when the facility had a "13-month" cost reporting period beginning before the base year and ending afterwards; this was one of very few comments that resulted in a substantive change in the final rule.
Prevailed on appeal to the 8th Circuit in University of Iowa Hospitals and Clinics v. Shalala, where HCFA disallowed costs on grounds of inadequate documentation absent any published policy putting the provider on notice that such documentation was required.
Represented a mental health provider and convinced an Assistant United States Attorney not to pursue a False Claims Act case against a provider when a HCFA audit found that all audited cases were erroneously paid.
Successfully represented the Harris County Hospital District in the first case arising under 1987–1989 amendments to Medicare legislation on the allowability of bad debts claimed in accordance with policies previously accepted by Medicare intermediaries; Harris County Hosp. Dist. v. Shalala, 64 F.3d 220 (5th Cir. 1995).
Successfully represented a group of more than 70 hospitals in contesting Medicare policy for computing inpatient average routine per diem cost, known as the "labor room day policy"; St. Mary of Nazareth Hosp. & Med. Ctr. v. Heckler, 760 F.3d 1311 (D.C. Cir. 1985).
Awards & Recognition
“Lawyer of the Year,” for Health Law in Washington, D.C. 2010, designated by The Best Lawyers in America
The Best Lawyers in America in health care law, 1997-2008
Chambers USA: America’s Leading Business Lawyers in health care law, 2005-2010, “Band One”
|Areas of Practice||1) Healthcare Industry , 2) Academic Medical Centers , 3) False Claims Act / Qui Tam Whistleblower , 4) Children’s Health , 5) RAC & MIC Audits and Appeals , 6) Healthcare Civil Litigation , 7) Health Govt Investigations , 8) Healthcare Regulatory and 9) Healthcare Reimbursement|
|Law School||J.D., University of Virginia|
|Education||B.A., Phi Beta Kappa, Ohio Wesleyan University|
|Bar Member / Association||State bar of District of Columbia|
|Most recent firm||King & Spalding LLP|
Associate Attorney - Insurance & Healthcare, Regulatory & Compliance
USA-NY-New York City
Based in either the firm's New York City or Florham Park, NJ office, the associate attorney is responsible for assisting and/or managing a caseload, subject to partner and senior associate supervision...
HEALTH POLICY ATTORNEY
TD&P Consulting, Inc. (TD&P) is a Washington, D.C., based applied health policy and litigation support firm that provides research, regulatory and compliance advice, future medical cost valuation, and...
Associate Paralegal - Intellectual Property
Associate Paralegal - Intellectual Property Responsibilities: Document organization for oppositions, Inter Partes Review proceedings, and preparatory global litigation work. Maintain filing systems ...
|+ View more jobs|
Ms. Fitzgerald represents employers in a wide range of industries, including the entertainment, financial services, hospitality, manufacturing, retail, and transportation industries.
Ms. Shander advises public and private company clients as well as private equity funds, with an emphasis on mergers and acquisitions, dispositions, and financing transactions.