Donna Thiel

Donna K. Thiel, shareholder in the Firm’s Washington, D.C., office, represents a broad range of health care providers and practitioners, including hospitals, nursing homes, rehabilitation providers, durable medical device suppliers and physicians.

Ms. Thiel concentrates her practice on regulatory issues affecting health care providers and practitioners in their operations, transactions and compliance efforts, with particular focus on Medicare and Medicaid payment systems.

Ms. Thiel has extensive experience in Medicare coverage, payment and compliance, as well as health care administrative litigation, including challenging claims denials and Zone Program Integrity Contracts (ZPIC), Recovery Audit Contractors (RACs) and Medicare Administrative Contractors (MACs) audits and defense of civil fraud enforcement and monetary penalties actions.

Ms. Thiel is proficient in developing models for joint ventures, physician-hospital relationships and contracts in compliance with reimbursement fraud and abuse and Stark Law principles. She advises clients on securitizations with Medicare receivables and provides reimbursement advice for joint ventures and corporate transactions, including provider-based and under-arrangement ventures.

Ms. Thiel addresses Medicare Part B coverage and billing issues and assists in obtaining coverage for new technologies. She routinely represents clients before the Centers for Medicare and Medicaid Services (CMS), the Office of the Inspector General (OIG) of the Department of Health and Human Services, and administrative law judges. Ms. Thiel also helps clients to manage, monitor and evaluate their compliance programs and billing operations.

Ms. Thiel has a comprehensive health care litigation background, including defense of civil fraud enforcement and monetary penalties actions, and she has represented clients before the Centers for Medicare and Medicaid Services, the Office of the Inspector General of the Department of Health and Human Services, and administrative law judges of the Office of Medicare Hearings and Appeals.

EDUCATION:

• Boston University School of Law, J.D., 1982
• Drew University, B.A., 1979, cum laude

ADMISSIONS:

• District of Columbia, 1982
• U.S. Supreme Court
• U.S. District Court, District of Columbia

Representative Matters:

• Argued one of the first Medicare exclusion cases to be appealed to federal court: Anesthesiologists Affiliated v. Sullivan, 941 F.2d 678 (8th Cir. 1991).
• Conducted an internal audit of Stark Law compliance in physician hospital contracts for a major academic medical center.
• Successfully challenged the use of an extrapolation based on audit overpayments based on statistical sampling methodologies.
• Defended a Maryland physician group for violations of the “incident to” coverage rules. Negotiated a $3 million settlement with DOJ.
• Represented an ambulance company in a potential exclusion based on the malfeasance of an owner in another company, ultimately negotiating the voluntary exclusion of the owner to preserve the Medicare certification of the subsidiary organization.

Professional Honors & Activities:

• Member – American Health Lawyers Association
• Member – D.C. Bar Association, Health Law Section
• Member – American Bar Association, Health Law Section