News

what we've done lately.

After commencing arbitration, sb2 recovers $1.6 mm from MCO for two of client’s behavioral healthcare facilities.

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sb2 successfully fends off MCO’s attempt to unilaterally change daily rate for skilled nursing care, saving client approximately $11,000 per day.

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sb2 uses proprietary strategy to recover $917,194.00 from MCO for long time client.

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Appellate court agrees with sb2 that administrative law judge violated resident’s due process rights when he dismissed her Medicaid appeal.

04/20/2022

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After ALJ dismisses Medicaid appeal for standing, sb2 convinces the PA Secretary for DPW to reopen the case.

04/13/2022

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sb2 again uses CMS Regulations to convince ALJ to exempt resident’s excess resources, obtaining Medicaid eligibility back to October ’20.

04/05/2022

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sb2 wins another Undue Hardship Waiver case when ALJ agrees that resident did not transfer assets solely for Medicaid planning purposes.

04/05/2022

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sb2 uses CMS’s spousal right of refusal regulations to qualify current resident back to August ’21.

03/28/2022

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sb2 gets MCO to pay over $1 mm in claims submitted by client using the common law to persuade MCO that a contract did in fact exist between the parties.

03/17/2022

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sb2 turns to CMS to force MCOs to allow provider to OME/income deviate resident coverage gaps, resulting in $272k payment.

03/06/2022

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ALJ agrees with sb2’s constitutional arguments and qualifies current resident for Medicaid back to December ’20.

03/01/2022

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For OH provider, sb2 appeals another LOC disenrollment by MCO and wins, recovering $85k for provider.

02/14/2022

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Utilizing little known Illinois regulation, ALJ agrees with sb2 and orders DHS to qualify resident for Medicaid back to 2017.

02/09/2022

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Prior to hearing on sb2’s appeal challenging availability of verification establishing OH resident’s eligibility for Medicaid, county issues NOE granting benefits.

02/04/2022

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