As a leading healthcare regulation attorney in Vermont, I am passionate about working alongside healthcare organizations and providers to navigate the evolution from fee-for-service to value-based reimbursement. I bring a deep level of understanding of the barriers faced by providers beyond the law itself, including cultural, financial, operational, employment, privacy, and technological. I work in collaboration with clients to ensure these barriers do not inhibit their success. My practice is solutions-oriented; I believe in identifying goals at the outset and in working together towards identifying solutions. My studies of healthcare delivery science and experience in change management allow me to continue to support organizations and individuals throughout implementation and evaluation of the solutions we have reached.
My goal is to provide strategic regulatory and legal advice to healthcare organizations as they implement organizational, structural and financial changes based on changing federal and state reimbursement mandates. As a recent graduate of Dartmouth’s Masters of Health Care Delivery Science program, I am able to offer healthcare organizations a level of business knowledge, operational expertise and legal skill that is not available elsewhere in the state. With secure knowledge of the current system, as well as the goals for the future, I am able to guide clients to success in both venues.
I have substantial experience in reimbursement issues involving both governmental and commercial payors, having litigated many disputes to conclusion and resolved many through negotiation. I regularly work with organizations participating in Vermont’s All Payer Model partnership with The Centers for Medicare & Medicaid Services (CMS).
- Successfully challenged limitation on use of prescriber identifiable data for PhRMA, Sorrell v. IMS Health, 131 S.Ct. 2653, 564 U.S. 522 (2011).
- Negotiated and drafted shared savings program agreements with Vermont Medicaid and commercial carriers on behalf of accountable care organizations.
- Regularly work with accountable care organizations on governance, contracting, compliance and strategy.
- Secured Certificate of Need for Genesis Healthcare to purchase 11 skilled nursing facilities.
- Negotiated exclusions of provider tax on home health agencies for out of state revenues and pass through revenues.
- Negotiated exclusion of nursing home transfer tax for transfer of real property on which home was located.
- 340B contracting.
- Secured return of over $1,000,000 to Vermont hospitals by the State Medicaid Agency, DVHA, as a result of underpayments resulting from the implementation of OPPS.
- Obtained a reduction of Medicaid lien on personal injury settlement proceeds before the Vermont Supreme Court.
- Participated in the formation of the Vermont Health CO-OP.
- Participated in the development of the skilled nursing facility IIDR process for Vermont.
- Received favorable IIDR decision on nursing home survey recommending removal of several IJ and substandard citations.
- Negotiate commercial reimbursement contracts.
- American Health Lawyers Association
- Vermont Bar Association
- National Association of Accountable Care Organizations
- Healthcare Financial Management Association
- Vermont Association of Hospitals & Health Systems
- U.S. Supreme Court
- U.S. Court of Appeals, Second Circuit
- U.S. Court of Appeals, Third Circuit
- U.S. District Court for the District of Vermont
- U.S. District Court , Southern District of New York
- New York
- New Jersey, inactive
- Pennsylvania, inactive
- Massachusetts, inactive