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Medicaid / Medicare

Our lawyers at Athene Law, LLP, stay on top of the latest in Medicaid and Medicare reimbursement issues.  We provide timely updates to our clients to put them on notice on important changes coming down the pike. Our lawyers use this expertise to manage problem-solving for clients to achieve the best possible outcomes.

We have handled Medi-Cal and Medicare administrative appeals on the following issues in the past few years:

  • Medi-Cal cost report audit adjustments (acute care cost-based reimbursement, acute care APR-DRG outlier reconciliation, and distinct part nursing facility rate setting)

  • Medi-Cal electronic health record (involving California’s attempt to replace the data utilized for calculating EHR incentive payments in contravention of their own manuals and the State Plan)

  • Medi-Cal reimbursement for 340B drugs

  • Indirect and direct graduate medical education from Medicare

  • Medicare Dependent Hospital status

Our lawyers are on the cutting edge of changing Medi-Cal reimbursement policies.  Felicia Sze has worked on numerous quality assurance fee issues for hospitals, skilled nursing centers, and ambulances, including drafting legislation, advising on implementation, and in defending programs from litigation challenges.  In addition, our lawyers have litigated challenges to reductions to Medi-Cal reimbursement rates.


Our attorneys advise clients on complex billing or payment issues.  We have recently advised several federally qualified health centers on the Medi-Cal ratesetting process.  Likewise, we have advised dozens of clients as to how to respond to suspected overpayments.

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