Holley Thames Lutz

With almost 30 years of practice exclusively in the healthcare space, Holley concentrates her practice on Medicare/Medicaid compliance activities related to coverage, reimbursement and enforcement issues, primarily for hospitals (academic medical centers and community-based). This practice includes serving as dedicated compliance counsel for several clients as well as serving in various hospital operations role, when necessary. From a proactive counseling perspective, Holley counsels clients in areas, including but not limited to, potential Medicare/Medicaid reimbursement impact of mergers and acquisitions, e.g., graduate medical education, successor liability, provider-based/remote locations, establishing clinical service lines in compliance with Medicare/Medicaid conditions of coverage and reimbursement, and compliance program and policy gap analysis and revisions to the same. Holley also counsels clients extensively in assessing and responding to allegations of non-compliance whether identified through routine compliance monitoring, a client’s internal compliance reporting system, an OIG/MAC/other Medicare contractor audit, survey activities related to EMTALA (and negotiating settlements with the OIG) or qui tam relators. Such counseling also involves assessing obligations to report/refund overpayments, developing arguments defending against alleged non-compliance (whether internal to client or raised by a regulator or enforcement agency), as well as counseling on responsive strategies for resolution of such allegations. Other substantive areas of focus are the Medicare Two-Midnight Rule, provider-based compliance, billing Medicare for clinical trials (drug and device), establishing compliant clinical trial billing practices, and Medicaid financing arrangements including provider-tax and supplemental payment models, including models rooted in Medicare/Medicaid Managed Care jurisdictions.