Iain Stauffer represents health care providers in matters involving Medicare and Medicaid reimbursement, compliance, enforcement, and litigation. He represents Medicare providers in multiple levels of Medicare appeals including redetermination, reconsideration, Office of Medicare Hearings and Appeals, and the Medicare Appeals Council. He also represents individual practitioners before various North Carolina licensing boards.
Iain served in the North Carolina Attorney General’s Office for more than a decade, most recently with the Public Assistance Section. In that position, he represented the North Carolina Department of Health and Human Services (NCDHHS) and the Division of Medical Assistance in matters involving Medicaid, post-payment audits, overpayments, provider enrollment denials and terminations, provider suspension actions, and claims denials complex litigation involving Medicaid before the Office of Administrative Hearings, Superior Court, North Carolina Business Court, and the North Carolina Court of Appeals.
Iain also provided advice and counsel in many areas of the Medicaid program, including compliance, program integrity, and managed care. Iain appeared in numerous actions at the Office of Administrative Hearings involving Medicaid audit, over-payment, reimbursement, and authorization matters. He participated in numerous reconsideration reviews on behalf of the Division of Medical Assistance on issues including Medicaid overpayments and Medicaid enrollment decisions. Iain's work also involved consulting and advising on complex legal issues regarding the operation of Medicaid programs in a managed care and fee for service structure, including the transition of North Carolina Medicaid to a managed care environment, and participating in rulemaking and drafted administrative rules related to Medicaid and other public assistance programs. As a Special Deputy Attorney General, he represented the NCDHHS in multiple federal class action lawsuits.
Iain clerked for the Honorable Sidney S. Eagles Jr., Chief Judge of the North Carolina Court of Appeals.