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Donna K. Thiel

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Donna Thiel, shareholder in the Firm's Washington, D.C., office, represents a broad range of health care providers and practitioners, including hospitals, nursing homes, rehabilitation providers, durable medical device suppliers and physicians.

Featured Experience

Argued one of the first Medicare exclusion cases to be appealed to federal court: Anesthesiologists Affiliated v. Sullivan, 941 F.2d 678 (8th Cir. 1991).

Conducted an internal audit of Stark Law compliance in physician hospital contracts for a major academic medical center.

Argued Provider Reimbursement Review Board (PRRB) cases on behalf of hospitals, skilled nursing facilities (SNFs) and home health agencies (HHAs) on issues such as the offset of interest income on zero coupon bonds, treatment of related party expenses and treatment of FICA and FUTA taxes, as well as Depreciation Recapture on Change of Ownership (CHOW).

Professional Biography

Overview

Ms. Thiel concentrates her practice on regulatory issues affecting health care providers and practitioners in their operations, transactions and compliance efforts, with particular focus on Medicare and Medicaid payment systems.

Ms. Thiel has extensive experience in Medicare coverage, payment and compliance, as well as health care administrative litigation, including challenging claims denials and Zone Program Integrity Contracts (ZPIC), Recovery Audit Contractors (RACs) and Medicare Administrative Contractors (MACs) audits and defense of civil fraud enforcement and monetary penalties actions.

Ms. Thiel is proficient in developing models for joint ventures, physician-hospital relationships and contracts in compliance with reimbursement fraud and abuse and Stark Law principles. She advises clients on securitizations with Medicare receivables and provides reimbursement advice for joint ventures and corporate transactions, including provider-based and under-arrangement ventures. Ms. Thiel addresses Medicare Part B coverage and billing issues and assists in obtaining coverage for new technologies. She routinely represents clients before the Centers for Medicare and Medicaid Services (CMS), the Office of the Inspector General (OIG) of the Department of Health and Human Services, and administrative law judges. Ms. Thiel also helps clients to manage, monitor and evaluate their compliance programs and billing operations.

Ms. Thiel has a comprehensive health care litigation background, including defense of civil fraud enforcement and monetary penalties actions, and she has represented clients before the Centers for Medicare and Medicaid Services, the Office of the Inspector General of the Department of Health and Human Services, and administrative law judges of the Office of Medicare Hearings and Appeals.

Ms. Thiel is also an active speaker and writer on health care regulation, compliance, fraud and abuse and reimbursement issues.

Representative Matters
  • Argued one of the first Medicare exclusion cases to be appealed to federal court: Anesthesiologists Affiliated v. Sullivan, 941 F.2d 678 (8th Cir. 1991).

  • Conducted an internal audit of Stark Law compliance in physician hospital contracts for a major academic medical center.

  • Argued Provider Reimbursement Review Board (PRRB) cases on behalf of hospitals, skilled nursing facilities (SNFs) and home health agencies (HHAs) on issues such as the offset of interest income on zero coupon bonds, treatment of related party expenses and treatment of FICA and FUTA taxes, as well as Depreciation Recapture on Change of Ownership (CHOW).

  • Argued on behalf of providers and suppliers at Office of Medicare Hearings and Appeals and Departmental Appeals Board on claims denials, including those based on RAC and ZPIC audit findings.

  • Successfully challenged the use of an extrapolation based on audit overpayments based on statistical sampling methodologies.

  • Successfully appealed issues regarding provider enrollment, including revocation of provider number enrollment date and revalidation issues.
  • Represented clients in OIG enforcement efforts, including under Operation Restore Trust and Operation Lab Scam. Oversaw self-disclosures, negotiated settlements and corporate integrity agreements (IAs) and supervised annual reporting under the CIA.

  • Defended a Maryland physician group for violations of the “incident to” coverage rules. Negotiated a $3 million settlement with DOJ.

  • Conducted internal compliance audits for a large academic medical center, a chain of SNFs, durable medical equipment (DME) suppliers and a rehabilitation and respiratory therapy supplier.

  • Served as special Medicare counsel for a publicly traded company in a national OIG/Medicaid/DOJ investigation of their long-term care businesses. Served as special Medicare counsel in its ultimate Chapter 11 reorganization – the largest SNF bankruptcy to date. Worked closely with the CMS General Counsel’s office addressing cutting edge issues of successor liability and assumption of liabilities in CHOWs and bankruptcy proceedings.
  • Represented an ambulance company in a potential exclusion based on the malfeasance of an owner in another company, ultimately negotiating the voluntary exclusion of the owner to preserve the Medicare certification of the subsidiary organization.

  • Conducted due diligence related to IPO for a pharmaceutical company, on pharmacy benefit management company agreements and on the sale of a pharmaceutical product from one pharmaceutical company to another.

Professional Honors & Activities
  • Listed in Chambers USA: America's Leading Business Lawyers as a leading lawyer in Healthcare (2009 – 2018)
  • Listed in Washington, D.C. Super Lawyers in Health Care Law (2012 – 2018)
  • Listed in Best Lawyers in America® in the area of Health Care Law (2017 – 2019)
  • Member – American Health Lawyers Association
  • Member – D.C. Bar Association, Health Law Section
  • Member – American Bar Association, Health Law Section
Publications
Speaking Engagements
  • "Health Care Predictions – What Can Physicians Expect?" (January 2018)
  • "Beware of the ZPIC – Tips and Tactics from the Trenches," AHLA Webinar (2011, 2013)
  • "Medical Necessity Appeals in Long Term Care," New England Health Information Management Association Annual Meeting (2012)
  • "Claims Appeals Fundamentals," American Health Lawyers Association Annual Medicare and Medicaid Institute, Baltimore (March 2012)

Industries

Education

  • Boston University School of Law, J.D., 1982
    • Editor, Annual Review of Banking Law
  • Drew University, B.A., 1979, cum laude

Admissions

  • District of Columbia, 1982
  • U.S. Supreme Court
  • U.S. District Court, District of Columbia
  • U.S. Circuit Court for the Eighth Circuit

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