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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In a significant decision, ALJ ignores that resident no longer met level of care because MCO failed to provide resident with care planning services prior to abruptly disenrolling her from plan.
04/17/2023
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Board of Review agrees that county’s failure to process Medicaid application filed in ’19 means that it’s still alive today.
04/13/2023
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Hearing Officer agrees with sb2’s constitutional arguments and directs caseworker to open denial and give resident more time to provide missing verifications to establish eligibility.
04/10/2023
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After taking over appeal of Medicaid denial for longtime client, sb2 unwinds $24k penalty/restricted period for current resident.
04/06/2023
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sb2 appeals denial of resident’s Medicaid application and secures 12 months of retroactive Medicaid coverage after recovering misused long-term care insurance payments.
04/03/2023
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sb2 walks longtime client through difficult Medicaid appeal ending with $80k recovery.
03/27/2023
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In another first, sb2 uses the ADA to secure conditional Medicaid eligibility for current resident waiting for a guardian to be appointed.
03/23/2023
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sb2 convinces caseworker to award Medicaid eligibility for current resident back to June ’21, even though former BOM missed stipulation deadline.
03/20/2023
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ALJ agrees with sb2’s argument and orders county to reopen resident’s application for Medicaid and provide additional time to provide missing verifications.
03/16/2023
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sb2 uses CMS Regulation on assistance to qualify current resident for Medicaid who was unable to fund his QIT because of incapacity.
03/13/2023
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In a first, ALJ directs county to conditionally approve resident’s Medicaid application due to incompetency without pending guardianship petition.
03/07/2023
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