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 and large provider force MCO to remit payment shortage for scores of residents covered under single case agreements.
06/28/2021
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ALJ agrees with sb2’s constitutional arguments, netting client $57k in Medicaid revenue.
06/23/2021
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For NJ provider, sb2 works with OPG to qualify resident for Medicaid back to October ’19.
06/17/2021
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Another appellate court sides with sb2 and overrules administrative law judge’s dismissal of client’s appeal, leading to $100k in Medicaid benefits for client.
06/15/2021
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ALJ agrees with sb2 that because of guardian’s inability to access disqualifying resources without a court order, caseworker should have granted resident’s Medicaid application back to May ’20.
06/09/2021
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MCO offers $195k to settle claims that it wrongfully included certain pharmacy charges in daily rate.
06/07/2021
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In tough state, appeal board agrees with sb2 that excess resources valued at $600k were not “available” resources as defined by CMS and overrules ALJ.
06/03/2021
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Hearing Officer agrees with sb2 that caseworker should have granted resident’s Undue Hardship Waiver with Medicaid benefits back to September ’20.
06/01/2021
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Days after filing appeal for failing to grant client’s request for conditional Medicaid benefits for current resident, caseworker approves resident’s application with benefits back to September ’20.
05/26/2021
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Appeal Board agrees with sb2 that state regulation allows providers (in certain instances) to file Medicaid appeals without a DAR.
05/24/2021
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sb2 pushes state to pay out on several notices of Medicaid eligibility, one for $108k alone, that have languished in a CMS unapproved department.
05/21/2021
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