Mark Gallant

Mark H. Gallant is co-chair of the firm’s Health Care Practice Group concentrating his practice in client counseling and litigation involving federal and state regulation of health care providers and third-party payers.

Prior to entering private practice in Philadelphia in 1988, Mark served as the deputy chief counsel to the Centers for Medicare & Medicaid Services in Washington, D.C., where he managed all litigation under the Medicare and Medicaid programs for the federal government nationally. Prior to that, Mark served for more than 10 years with the Civil Division of the U.S. Justice Department and U.S. Attorney’s Office in D.C.

He has written and lectured widely for the American Health Lawyers Association, Pennsylvania Bar Association, and other organizations on Medicare and Medicaid reimbursement, state/federal regulations under the Medicaid program, Medicaid managed care and compliance with health care fraud and abuse laws, and serves as a co-chair of AHLA’s annual Medicare and Medicaid Reimbursement Institute.

He also is the author of the Medicaid Reimbursement section of the American Health Lawyers Association (Clark, Boardman, Callaghan) Health Law Practice Guide and speaks regularly at AHLA and Pennsylvania Bar Institute programs on governmental and third-party payer health care reimbursement and fraud issues. He also serves as a planning committee member and co-chair for AHLA’s Annual Medicare and Medicaid Reimbursement Institute in Baltimore.

Mark has served as counsel of record in litigation and other matters for health care systems, hospitals, pharmacy chains, durable medical equipment manufacturers and suppliers, long-term care providers, and for national and state trade associations. Mark’s representative matters for health care industry clients have included:

• Litigation resulting in the invalidation of CMS reaudit rule that prevented teaching hospitals from adding misclassified teaching costs to their base-year Average Per Resident Amounts.
• Defense of False Claim Act investigations and qui tam suits, including settlement of a Medicare “outlier” fraud case with no corporate integrity agreement.
• Formulation and legal audits of provider taxes and intergovernmental transfers (IGTs) on behalf of hospital, trade association, and governmental clients.
• Litigation resulting in the Third Circuit University Medical Center rule (prohibiting Medicare recoupments against health care providers operating in bankruptcy reorganization).
• Part A reimbursement hearings before the Provider Reimbursement Review Board, including a PRRB decision striking CMS’ requirement for filing duplicate claims forms with Part A intermediaries as a condition of receiving medical education supplements for Medicare managed care enrollees.

Mark earned his undergraduate degree from Rutgers University-New Brunswick in 1972 and his law degree from Georgetown University Law Center in 1975.

EXPERIENCE :

• Represented New Jersey Hospital Association in New Jersey Hospital Ass’n v. Waldman, 73 F.3d 509 (3d Cir. 1995). Challenge by New Jersey hospitals to reduction of DRG rates and adequacy of disproportionate share payments.
• Represented Children’s Seashore House in Children’s Seashore House v. Waldman, 197 F. 654 (3d Cir. 1999), affirming constitutional claim to require state to pay Medicaid disproportionate share adjustments to out-of-state providers.
• Assisted a local hospital obtain training reimbursement rates from Medicare after an eight year fight from the initial administrative appeal challenging the government’s interpretation of its re-audit rules to a federal case in the Third Circuit. The court ordered the government to recalculate its reimbursements without reliance on its discriminatory re-audit rule.
• Defended a multi-state provider of behavioral health services against a False Claims Act suit brought by the federal and state governments, and advised the client with respect to its obligations under a resulting Corporate Integrity Agreement.
• Represented physician group practices before the New Jersey Board of Medical Examiners in connection with compliance with the New Jersey anti-referral law, commonly referred to as the “Codey Law.”
• Represented a national pharmacy chain in various regulatory counseling on manufacturer rebate programs, patient refill compliance programs, federal fraud and abuse compliance, and issues related to an affiliated PBM.
• Represented the National Association of Chain Drug Stores on numerous projects, including a comprehensive analysis of the statutes, regulations, and case law governing reimbursement requirements and rate reductions by State Medicaid programs and in the Massachusetts District Court AWP rebate and pricing litigation.
• Represented national nursing home chain in Medicare Part A appeals involving “related party” (institutional pharmacy) reimbursements.

EDUCATION :

• Georgetown University Law Center, J.D., 1975
• Rutgers College, A.B., 1972

BAR ADMISSIONS : District of Columbia; Pennsylvania

COURT ADMISSIONS :

• U.S. Court of Appeals for the District of Columbia Circuit
• U.S. Court of Appeals for the Sixth Circuit
• U.S. Court of Appeals for the Tenth Circuit
• U.S. Court of Appeals for the Third Circuit
• U.S. District Court — Eastern District of Pennsylvania
• U.S. Supreme Court

AFFILIATIONS :

• American Bar Association
• American Health Lawyers Association
• Pennsylvania Bar Association