John W. Kaveney

Professional Memberships

Healthcare Financial Management Association New Jersey Chapter: CARE (Compliance, Audit, Risk & Ethics) Forum

New Jersey State Bar Association

American Health Law Association

Work Highlights

Representing 170 hospitals nationwide before the Medicare PRRB in challenges to CMS’ historical calculation of IPPS rates dating to federal fiscal year 1986. The matter, valued in the hundreds of millions of dollars, seeks correction of longstanding reimbursement underpayments and remains pending before the PRRB.

Representing over 300 hospitals nationwide in Medicare PRRB and federal court litigation challenging CMS’ application of the rural floor budget neutrality factor affecting federal fiscal year 2024 wage indices. The firm secured expedited judicial review and filed suit in the U.S. District Court for the District of Columbia seeking declaratory relief and damages.

Representing 173 hospitals nationwide in Medicare PRRB proceedings challenging CMS’ exclusion of Section 401 hospital wage data from rural floor reimbursement calculations. This Medicare reimbursement matter, valued in the hundreds of millions of dollars, remains pending before the PRRB.

Representing an emergency medicine physician practice in a dispute exceeding $11 million against UnitedHealthcare and affiliated entities arising from post-breach recoupment efforts following the Change Healthcare cyber incident, advising on recovery of lost revenue and structuring a resolution to preserve the practice’s financial viability.

Defending a major New Jersey health system against physician privilege-termination claims, including allegations of discrimination and improper peer review, where reinstatement would raise patient safety concerns; discovery completed and summary judgment pending.

Representing two New Jersey health systems in high-stakes litigation against multiple Medicare Advantage plans seeking recovery of approximately $5 million in underpaid 340B drug reimbursements, following a U.S. Supreme Court decision invalidating the Center for Medicare and Medicaid Services’ reimbursement reductions; matters are proceeding toward mediation and arbitration.

Advising a local government agency on the formation of a compliant “friendly P.C.” structure for the operation of New Jersey’s largest psychiatric hospital, including drafting and negotiating all transactional and governance documents under New Jersey healthcare law.

Served as lead counsel to a healthcare system in a high-profile legislative and appellate initiative to renew New Jersey’s involuntary commitment law, coordinating testimony before multiple legislative committees, negotiations with state agencies, and appellate advocacy,

culminating in passage and gubernatorial signing of legislation with statewide impact on hospital emergency care and public safety.

Serving as outside regulatory counsel to a multispecialty provider of healthcare services, leading internal investigations and compliance reviews in response to federal scrutiny of physician billing practices, including platelet-rich plasma therapy and “incident-to” billing, and guiding corrective action to mitigate fraud-and-abuse exposure and protect Medicare participation.

Advising a New Jersey-based applied behavioral analysis therapy organization in responding to a New Jersey MFD audit. This matter includes counseling the client on the MFD interview process, assisting in providing relevant documentation responsive to the audit, and advising the client on compliance with follow-up requests from the MFD in anticipation of an eventual resolution of the audit, including any repayment demands.

Representing a pharmacy in restoring Medicare certification, resolving conditions-of-participation violations and securing CMS approval for re-enrollment, allowing the business to resume serving Medicare beneficiaries.

Guiding an outpatient psychiatry practice through Medicare and Medicaid compliance remediation, addressing opted-out Medicare billing issues and regulatory inquiries to preserve continued operations and avoid enforcement action.

Represented a global pharmaceutical company in successfully petitioning the New Jersey Supreme Court for special in-house licensure, enabling out-of-state counsel to practice in New Jersey on a permanent basis.

Career

John advises healthcare sector clients on a broad range of regulatory, reimbursement, compliance, privacy, licensure, and operational matters affecting healthcare providers and organizations. He represents hospitals and health systems, academic medical centers, physicians and physician groups, ambulatory surgery centers, ancillary service providers, medical billing companies, skilled nursing and rehabilitation facilities, behavioral health centers, and pharmacies.

He counsels clients on Medicare and Medicaid reimbursement matters, including proceedings before the New Jersey Division of Medical Assistance and Health Services (DMAHS) and the federal Provider Reimbursement Review Board (PRRB).

John advises healthcare clients on corporate compliance matters, including the development, assessment, and implementation of compliance programs, audits, internal investigations, governmental investigations, self-disclosures, and repayment obligations. His practice includes counseling on issues arising under the federal Stark Law, Anti-Kickback Statute (AKS), Civil Monetary Penalties law (CMP), and other state and federal healthcare laws.

He also advises providers on healthcare privacy and cybersecurity matters involving HIPAA and Health Information Technology for Economic and Clinical Health Act (HITECH) compliance, including privacy and security policies, protected health information (PHI), business associate relationships, data breach investigations, reporting obligations, and remediation efforts.

In addition, John assists healthcare providers with professional licensure matters, medical staff bylaws and disciplinary proceedings, internal investigations, and issues involving New Jersey’s involuntary commitment laws. He also represents clients in civil litigation matters.

John serves as Editor-in-Chief of Healthcare Perspectives, the firm’s healthcare industry blog.

Education

Awards