Administrative Appeals and Hearings

Athene Law is the go-to firm in California for handling complex administrative appeals on behalf of healthcare providers. In an industry consistently subject to intense governmental scrutiny, particularly in billing and reimbursement, Athene Law ensures that healthcare providers pursue their full right to payment for services that they render to enrollees in public health insurance programs. 

We also represent healthcare providers defending against licensing and certification citations, privacy breach penalties and medical waste citations. We are also closely monitoring new developments from the Department of Health Care Affordability and Information, including anticipated enforcement related to financial assistance policies and health care affordability. 

Athene Law protects the interests of our clients so they can focus their resources on providing high-quality care to their patients. Since our founding, Athene Law has secured tens of millions for hospitals in Medicare and MediCal reimbursement appeals and also prevailed in numerous judicial appeals arising from reimbursement audits. We have also settled numerous cases resulting in increased payments to California clinics.

Capabilities

Athene Law has experience representing numerous provider types in administrative appeals and hearings, including:

Centers for Medicare & Medicaid Services appeals

• Provider Reimbursement Review Board, including cost report adjustments, Federal Register rulemaking appeals, geographic reclassification, Medicare dependent hospital status, application of TEFRA limits to children’s hospitals, direct and indirect graduate medical education reimbursement, and sole community hospital status
• Departmental Appeals Board, including sanctions against PACE programs, OIG exclusions, Medicare revocation actions, Medicare enrollment effective dates, Medicare Overpayment and Denial Appeals, Medicare Administrative Contractor redeterminations, QIC reconsiderations, OMHA ALJ hearings, and Medicare Appeals Council reviews
• State Medicaid/Medi-Cal appeals, including Office of Administrative Hearings and Appeals, cost report adjustments, square footage reductions, allocation of administrative and general costs, Assembly Bill 85 appeal, FQHC/RHC ratesetting appeals, related party, disallowance of nurse staffing costs in NICU, incentive payment appeals, marketing costs, DPNF bed holds, emergency services claims dispute for non-contracted emergency service claims, and specialty mental health services certifications
• California Department of Public Health, including licensure citations, privacy breach violations, and medical waste violations