Will enjoys a good challenge. Whether it is involves taking up telemark skiing as a 40- something, or pressing a novel legal theory, his approach is simple: a can do attitude, creative thinking, good old fashioned hard work, and, most importantly, keep it fun (and yes, even Medicare and Medicaid reimbursement can be fun).
Although most peoples’ eyes glaze over at the mere mention of Medicare and Medicaid regulations, Will has a strange infatuation with making sure that his health care industry clients are properly reimbursed for the important services that they provide. He enjoys appearing before the Medicare Provider Reimbursement Review Board (as well as State Medicaid agency hearing officers), and relishes the opportunity to poke holes in governmental overpayment determinations. He speaks fluent Medicare and Medicaid, including the unique dialects of DSH, TEFRA, CAH, GME, SCH, MDH, MSP and TPL. Will’s approach has helped his clients obtain well over $100 million of additional Medicare and Medicaid reimbursement (and has saved his clients millions more defending against overpayment claims).
A frustrated closet author at heart, Will believes that a simple and compelling story usually lies beneath even the most complex litigation, and success often depends upon teasing out a simple message, and sharing that story through witnesses, supporting data, and crisp writing.
Will is passionate about his family, travel, food and winter. A die-hard “Sugarloafer” (ask me), he hasn’t yet given up on his dream of appearing in an extreme telemark ski movie.
MaineGeneral Medical Center v. Shalala, 205 F.3d 493 (1st Cir. 2000) — Successfully overturned the Medicare Provider Reimbursement Review Board''s refusal to hold an administrative hearing regarding a self-disallowed cost. A self-disallowed cost is a cost that is eligible for Medicare payment, but the hospital mistakenly omits the claim in its year end cost report. The case was significant because the First Circuit expanded the PRRB''s jurisdictional powers to cover self-disallowed costs. This decision created a split in the circuits (other circuits determined that the PRRB did not have the authority to hear disputes regarding self-disallowed costs).
In re: Review of Aggregate Measurable Cost Savings by Dirigo Health — For four years (2005 - 2008), represented the Maine State Chamber of Commerce as lead intervenor in administrative hearings before the Dirigo Health Agency ("DHA") and the Superintendent of the Maine Bureau of Insurance. The hearings examined aggregate measurable cost savings ("AMCS") allegedly realized by Maine''s health care system as a result of the Dirigo Health Reform Act. The savings determined by the DHA and approved by the Superintendent formed the basis of the savings offset payment ("SOP"), an assessment on health insurance carriers. Because the SOP, by law, was to be incorporated into a health insurer''s premium, the stakes were high for Maine''s business community, who viewed the SOP as a tax on health insurance. Our work substantially lowered the SOP each of the four years for which there were hearings, savings Maine''s business community (the major purchasers of health insurance) tens of millions of dollars each year.
The Aroostook Medical Center, et. al. v. State of Maine DHHS — Lead attorney representing nine Maine hospitals in coordinated litigation and administrative appeals against the State of Maine Department of Health and Human Services MaineCare (Medicaid) program. Resulted in a landmark $85 million legal settlement in favor of our hospital clients.