Deborah Kantar Gardner
Deborah Kantar Gardner is a Boston-based partner in Ropes & Gray’s health care practice. Ms. Gardner’s practice focuses on Medicare and Medicaid payment, compliance and enforcement matters, including administrative and judicial litigation in connection with Medicare and Medicaid payment matters. Deborah’s clients include hospitals and health systems, health plans/managed care organizations, clinical diagnostic laboratories, dialysis and pharmaceutical companies, physician and therapy practices, and durable medical equipment suppliers.
Deborah defends health care entities in connection with federal and state civil False Claims Act investigations and qui tams. She represents clients in connection with Administrative Law Judge appeals of Recovery Audit Contractor, Zone Program Integrity Contractor and Medicaid Integrity Contractor audits as well as with respect to Provider Reimbursement Review Board appeals.
Deborah counsels clients on compliance with federal health care program authorities, including Medicare and Medicaid, and federal fraud and abuse laws. She represents clients in connection with Medicare enrollment and survey and certification matters, including terminations. She also advises clients on Medicare billing, coding and payment matters.
False Claims Act, Medicare and Medicaid Program Integrity Audits
- Conducted and assisted in the resolution of an investigation into a residential service provider jointly conducted by the New York Attorney General’s Medicaid Fraud Control Unit and the United States Attorneys’ Office for the Southern District of New York.
- Successfully defended a major New York health system in connection with a False Claims Act investigation brought by the United States Attorneys’ Office for the Southern District of New York.
- Successfully represented two major health systems in connection with False Claims Act investigations brought by the U.S. Department of Justice and the United States Attorneys’ Office for the Southern District of Florida into the Medicare coverage of implantable cardioverter defibrillators.
- Successfully represented a New York hospital in connection with a Medicare program integrity audit of the medical necessity and inpatient admission for certain cardiac procedures.
- Successfully represented several hospitals in challenges to Medicare and Medicaid program integrity and Recovery Audit Contractor audits.
Administrative and Judicial Litigation
- Successfully represented many hospitals in cost report and reimbursement appeals at the Provider Reimbursement Review Board and in the federal district and circuit courts.
- Successfully represented health care entities in numerous Administrative Law Judge and Medicare Appeals Council appeals involving, among other things, issues of medical necessity and/or inpatient status.
- Successfully represented numerous hospitals and a dialysis provider in Medicare certification challenges.
- Successfully represented a national radiology group in connection with an appeal of a billing revocation.
- Regularly assists diagnostic laboratories in connection with Medicare payment suspensions, Medicare program integrity audits, and commercial payor disputes.
- Successfully represented a medical device company in connection with state licensing appeals and commercial payor issues.
Regulatory Compliance and Payment Matters
- Successfully represented many hospitals in connection with Medicare termination proceedings and System Improvement Agreement negotiations.
- Advises healthcare entities on Medicare and Medicaid coverage and payment issues, including medical necessity, two-midnight rule, provider-based status, physician supervision, incident-to, bundled payment models, outlier payments, therapy and lab billing, and the implications of regulatory changes.
- Counsels health care entities on compliance with Medicare and Medicaid authorities, including billing and coding, survey and certification, charges and co-payments, reporting and returning overpayments, and self-disclosures.
- Counsels health care entities regarding compliance with fraud and abuse authorities.
- Represents Medicaid Managed Care Organizations in connection with qui tam defense, contracting and compliance.
- Advises clients on compliance risk assessments, programs and policies.
- Quoted, “Healthcare reform can create confusion over compliance for providers,” Healthcare Dive (February 7, 2017)
- Co-author, “Taming the ‘Wild West’: Enforcement Trends and Reimbursement Issues Facing Independent Clinical Laboratories,” Bloomberg BNA Health Law Reporter (April 14, 2016)
- Co-author, “Laboratory Phlebotomists in Physician Offices? States Increasingly Saying ‘No,’” Bloomberg BNA’s G2 Intelligence (February 2014)
- Presenter, “Is Your EHR Getting You in Hot Water?” Greater New York Hospital Association (April 17, 2017)
- Speaker, “Winners and Losers in the Provider Sector in the Movement to Value-Based Health Care,” Ropes & Gray Teleconference (April 2017)
- Presenter, “The Federal False Claims Act post-Escobar: Compliance Priorities Following Universal Health Services v. Escobar,” Healthcare Financial Management Association (December 9, 2016)
- Presenter, “Avoiding Regulatory Scrutiny and Getting Paid: Compliance and Reimbursement in Challenging Time,” G2 Intelligence: Lab Institute 2016 (October 27, 2016)
- Presenter, “Escobar and the Implied False Certification Doctrine: Compliance Priorities Following Escobar,” Greater New York Hospital Association (September 15, 2016)
- Presenter, “Overpayments, Short Stays and Outpatient Reimbursement: Addressing Major Changes to CMS Rules in 2016,” Massachusetts Hospital Association (March 2016)
- Presenter, “Compliance in the Wake of the ACA,” Suffolk Law Panel (November 2013)
- Presenter, “In the Wake of the WakeMed Settlement: Strategic Considerations for Compliance and Response to Enforcement Action,” Ropes & Gray, LLP Teleconference (February 28, 2013)
- Presenter, “Legal and Compliance Update, Reimbursement, Billing and Coding,” Healthcare Financial Management Association (December 2012)
- Presenter, “Healthcare Beyond the Crossroads: Healthcare Reform after the Supreme Court Ruling: Follow-up Report,” Ropes & Gray LLP Teleconference (October 2012)