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Biography
Since the early seventies, J.D. has limited his practice to health care issues, and has represented thousands of hospitals, nursing homes, home health agencies, HMOs, prepaid group practices, medical staffs, and related clients throughout the country. His representation of these clients has included appearing before administrative appeals boards, such as the Provider Reimbursement Review Board and Blue Cross Association Medicare Provider Appeals Committee, and in the federal courts. It has also included negotiating and settling disputes relating to Blue Cross and other third-party payor contracts. J.D. consults with clients in such areas as third-party reimbursement; fraud and abuse, Stark, and federal False Claims Act matters; corporate organization; acquisitions, mergers, and consolidations; structuring and contracting for HMOs, PPOs, PHOs, PSOs, integrated delivery systems, and managed care networks; utilization reviews; and physician, paramedical, and vendor contracts.
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Representative
Experience
- Represented a state hospital association and most of their hospital members in the first group appeal prosecuted before the Provider Reimbursement Review Board (PRRB) culminating in a multiple million dollar victory in the federal courts
- Represented a catholic hospital system in successfully prosecuting two separate million dollar plus disputes through the D.C. Court of Appeals motivating the Department of HHS to revise their regulations
- Represented a hospital system in a group appeal before the PRRB concluding in a favorable settlement with the Department of HHS in excess of $8 million
- Represented an academic medical center in negotiating a settlement of their medical education cost dispute with the Department of HHS resulting in increased payments to the medical center in excess of $20 million
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Activities and Affiliations
- Past President: American Academy of Hospital Attorneys (AAHA)
- Co-Chair: Medicare and Medicaid Payment Institute for its first 21 years of existence
- Board Member: American Medico-Legal Foundation; Health Law and Policy Institute, University of Houston Law Center; March of Dimes Birth Defects Foundation National Office of Volunteers; Gulf Coast Chapter of the March of Dimes (Past Chair; current Executive Committee Member); The University of Texas Medical Branch at Galveston Development Board; University of Illinois Law School Board of Visitors
- Listed: Chambers USA: America's Leading Business Lawyers in healthcare law, 2004-2006; The Best Lawyers in America in healthcare law, 2005 and 2006; Texas Super Lawyer in healthcare law, Texas Monthly, 2003-2005; "Forty Best Health Lawyers," National Law Journal; One of twelve "Outstanding Hospital Lawyers" by Nightingale's Healthcare News
- Adjunct Professor: University of Houston Law Center; Clinical Adjunct Professor: St. Louis University
- Editorial Advisory Board: Aspen's Topics in Health Law and Home Health Newsletter; American Health Consultants' Home Care Economics
- Co-Author: "Unique Aspects of Texas Health Law," Guide to the Leading U.S. Healthcare Lawyers, December 2005; Medicare Reimbursement Controversies (Aspen), Appeals and the Provider Reimbursement Review (Aspen), Health Law Handbook (West), and Health Care Administration (Aspen)
- Lecturer: annual seminars for hospital associations, financial associations, and other private and public organizations on physician/hospital relations, fraud and abuse, integrated delivery systems, third-party payment systems, health reform and appeals
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Education and Professional Background
- University of Illinois, B.S., 1965; J.D., 1967
- U.S. Army, Artillery Officer, 1967-1969
- Admitted to practice: Illinois, 1970; Texas, 1974; D.C., 1978; United States Supreme Court; state and federal courts of Illinois, Texas and the District of Columbia; various Circuit Courts of Appeals
- National Blue Cross Association, Associate Counsel, 1969-1974
- Wood Lucksinger & Epstein, 1974-1991 (Managing Partner, 1983-1991)
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