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Health Care

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Medicare, Medicaid, and Private Payor Reimbursement

We advise our clients on a broad spectrum of third-party reimbursement issues, including Medicare, Medicaid and private payor reimbursement. We regularly counsel our clients concerning the impact of the complex government program reimbursement requirements on their business operations and work with our clients to assure that their billing and coding practices comply with applicable legal requirements. We also advise clients regarding the process and implications for disclosing overpayments to Medicare, Medicaid and private payors.
Partners
Allred, Allen D.
Buchholz, Edward J.
Fink, Jeffrey R.
Fogle, James L.
Friedman, Lawrence C.
Goldfarb, Evan Raskas
Goturi, Milada R.
Gunn, James F.
Hennessy, Joyce Harris
Landwehr, Matthew J.
Lause, Michael F.
Lawton, Richard L.
Mayes, Gary
Miller, Jan Paul
Schenk, Claire M.
Associates
Oliver, Tonya M.
  • AmeriNet, Inc.
  • Anderson Hospital
  • Ascension Health
  • Bethesda Health Group
  • BJC Health System
  • Community Living, Inc.
  • Cooperative Home Care
  • CoreLink, LLC
  • Essence Group Holdings Corporation
  • The Gatesworth
  • Hillsboro Area Health System
  • McKnight Place Assisted Living
  • McKnight Place Extended Care
  • Mercy Health
  • Midwest Neurosurgeons, LLC
  • Parc Provence
  • Pharmerica Corporation
  • Prairie Spine & Pain Institute
  • QualSight, Inc.
  • Ranken Jordan, A Pediatric Specialty Hospital
  • Saint Anthony’s Health System, Alton, IL
  • Saint Peters Bone and Joint Surgery, Inc.
  • Sparta Community Hospital
  • St. Charles Orthopaedic Surgery Associates
  • St. Edward Mercy Medical Center, Fort Smith, AR
  • St. John’s Health System, Springfield, MO
  • St. John’s Mercy Medical Center, St. Louis, MO
  • United Healthcare Group
  • Thompson Coburn obtained a major victory for United Healthcare, who was sued by Signature Health Services, Inc., a 120-physician group, seeking to hold United Healthcare liable for millions of dollars in penalties under the federal racketeering statute (RICO) and the Missouri Prompt Payment Act. Signature also asked the court to revamp United Healthcare’s claim processing system. In May 2006, the district court ruled in favor of United Healthcare and rejected Signature’s claims. In March 2009, the Eighth Circuit affirmed the district court’s judgment. In a unanimous decision, the Eighth Circuit ruled that Signature did not have a viable RICO claim. 
  • We represented a health insurer in a class action lawsuit in Missouri alleging that the health insurer imposed copayments for medical services and outpatient prescription drugs that allegedly exceeded copayment limits in the health insurer’s ERISA-governed health plans and the Missouri Department of Insurance Copayment Regulation. 
  • We represented several hospitals in class action lawsuits in Missouri, Illinois and Arkansas brought by uninsured patients who alleged that the hospitals overcharged them for medical services because the hospitals did not afford to the uninsured patients the same discounts from the hospitals’ standard charges that the hospitals afforded to insurance companies pursuant to provider agreements or to the Medicare and Medicaid programs pursuant to statutes. Several of these lawsuits have been dismissed for failure to state a viable claim against the hospitals. In one lawsuit, class certification was denied. 
  • We represented a hospital in a class action lawsuit in Illinois challenging the hospital’s practice of asserting health care provider liens for the full amount of billed charges in automobile accidents where the patients had insurance coverage with insurers that had a provider agreement with the hospital under which the hospital agreed to accept a discounted payment from the insurers as payment in full. 
  • Our attorneys served as letter of credit bank counsel in connection with more than $400 million in bond and other financings for PeaceHealth, an integrated multistate hospital and health care system in the Pacific Northwest. The bonds were structured as variable rate securities issued by two state authorities and were enhanced by bank letters of credit provided by a syndicate of multiple banks led by two issuing banks. The firm documented both the bond letter of credit materials, as well as the bank syndicate materials. Our attorneys also represented the bank group agent in connection with a bridge line of credit that allowed the hospital system to access the credit markets in advance of the bond financing in order to avoid rising interest rates on its existing bond indebtedness. 
  • We assist clients with respect to the administration of retiree medical plans. We also counsel and defend clients with respect to the modification and termination of such plans. We successfully initiated a defendant class action related to our client, materially reducing its retiree medical benefits. 
  • We have represented numerous clients in negotiating, documenting and implementing merger, asset acquisition, membership interest/stock acquisition, joint venture, religious sponsorship and affiliation transactions for nonprofit and for-profit clients.