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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sb2 obtains Medicaid eligibility for 3 current residents for two providers after filing Inaction Appeals based on MCO’s failure to comply with state’s MCO master contract approved by CMS.
01/20/2023
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After Board of Review affirms that provider was entitled to notice and a hearing to dispute disenrollment of current resident, MCO settles matter for nearly $40k.
01/17/2023
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sb2 qualifies current resident for Medicaid effective June ’22 after appealing Medicaid denial and proving that missing verifications were unavailable.
01/12/2023
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sb2 uses CMS mandated provisions in State Master Contract to open MCO’s defective notice denying 8 months of Medicaid coverage for current resident.
01/09/2023
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sb2 qualifies current resident for Medicaid effective June ’22 after appealing Medicaid denial and proving that missing verifications were unavailable.
01/06/2023
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For large provider of laboratory pathology services, sb2 uses CARES Act to force MCO to pay rate published on provider’s website for COVID tests.
01/04/2023
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After winning appeal before ALJ, sb2 secures UHW for alleged transfers of assets for no consideration on behalf of current resident and full Medicaid retroactivity.
12/28/2022
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Appellate Court agrees with sb2’s constitutional arguments and overrules state hearing board’s refusal to give resident a hearing to determine if Medicaid denials were defective.
12/20/2022
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sb2 recovers $52k for assisted living facility using petition filed with the Probate Court, opting not to pursue a civil action seeking collections.
12/13/2022
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Using new state policy on conditional Medicaid approval, county offers to settle sb2’s pending appeal, agreeing to approve all but one month of coverage gap.
12/08/2022
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Prior to hearing on appeal filed by sb2, county agrees that resident was in fact a resident of that state even though she still owned a home in another.
12/01/2022
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