Donna Thiel

Donna K. Thiel

Partner
About

Donna Thiel concentrates her practice in the areas of health care reimbursement, fraud and abuse, and compliance. She works with clients to address the complex issues arising under the Medicare program. Her counselling relates to Medicare reimbursement of all types of providers, practitioners and suppliers. Donna works daily with the arcane rules addressing who can bill, where, under what circumstances, under what payment system and for how much reimbursement.

She is also well versed in the requirements of the federal anti-kickback statute and the Stark Law. She guides clients through these complex laws with the goal of creating compliant arrangements and securing proper payment for services rendered. When audits and enforcement actions are launched, Donna defends her clients based on her deep understanding of the statutes and regulations as well as sub-regulatory guidance that governs clients' relationships with federal healthcare programs.

In addition to working with providers such as hospitals and skilled nursing facilities, she has a wealth of experience in the representation of physicians, therapists, nurse practitioners, DME suppliers, pharmacy, laboratory and diagnostic facilities.  

Donna has a comprehensive health care litigation background, including defense of civil fraud enforcement and monetary penalties actions. 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.

Bar admissionsDistrict of ColumbiaSupreme Court of the United States
CourtsUnited States District Court for the District of ColumbiaUnited States Court of Appeals for the Eighth Circuit

EXPERIENCE

  • 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
  • Argued Provider Reimbursement Review Board cases on behalf of hospitals, skilled nursing facilities (SNFs) and home health agencies on issues such as the offset of interest income on zero coupon bonds, treatment of related party expenses and treatment of FICA and FUTA taxes, as well as Depreciation Recapture on Change of Ownership
  • Argued on behalf of providers and suppliers at Office of Medicare Hearings and Appeals and Departmental Appeals Board on claims denials, including those based on RAC and ZPIC audit findings
  • Challenged the use of an extrapolation based on audit overpayments based on statistical sampling methodologies
  • Appealed issues regarding provider enrollment, including revocation of provider number enrollment date and revalidation issues
  • Represented clients in OIG enforcement efforts, including Operation Restore Trust and Operation Lab Scam, while overseeing self-disclosures, negotiated settlements and corporate integrity agreements and supervised annual reporting under the CIA
  • Defended a Maryland physician group for violations of the "incident to" coverage rules and negotiated a US$3 million settlement with DOJ
  • Conducted internal compliance audits for a large academic medical center, a chain of SNFs, durable medical equipment suppliers and a rehabilitation and respiratory therapy supplier
  • Served as special Medicare counsel for a publicly traded company in a national OIG, Medicaid and DOJ investigation of their long-term care businesses; served as special Medicare counsel in the company’s ultimate Chapter 11 reorganization – the largest SNF bankruptcy to date; worked closely with the CMS General Counsel's office to address cutting-edge issues of successor liability and assumption of liabilities in CHOWs and bankruptcy proceedings
  • 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
  • Conducted due diligence related to the IPO for a pharmaceutical company, on pharmacy benefit management company agreements and on the sale of a pharmaceutical product from one pharmaceutical company to another
Education
  • A.B., Drew University
    cum laude
  • J.D., Boston University School of Law

Awards

  • Chambers USA
    • Band 2, District of Columbia Healthcare (2020-2023)
    • Band 3, District of Columbia Healthcare (2019)
  • The Legal 500 United States
    • Recommended, Healthcare: Service Providers (2022-2023)
  • Washington, DC Super Lawyers in Health Care Law (2012-2018)
  • Best Lawyers in America in Health Care Law (2017-2019)

Bylines

  • "CMS Brings Changes to Nursing Home Compare and Five-Star Ratings in April 2019," 2019
  • "CMS Expands Telehealth Benefits Available to Medicare Advantage Patients," Payment Matters, 2019
  • "The New Option in Town: Applying for the Low Volume Appeals Settlement," 2018
  • "HHS Seeks to Ease Burden of Hurricane on Health Care Organizations," 2017
  • "CMS Releases MACRA Proposed Rule for 2018," 2017
  • "CMS Proposes to Eliminate Therapy-Driven SNF Reimbursement," Payment Matters, 2017
  • "HHS Publishes Final Rule Overhauling the Medicare Appeals Process," Payment Matters, 2017
  • "CMS Issues Final Rule Outlining FY17 Medicare Payment Policies and Rates for SNF PPS," 2016
  • "Big Payment Changes Revealed In New Medicare Part B Drug Payment Test," 2016
  • "Medicare Claims Appeals: From Audit to OMHA (A.L.J.)," American Health Lawyers Association (AHLA) Institute on Medicare and Medicaid Payment Issues, 2012-2015
  • Co-author, "Ebola Preparedness Plans: Interim Guidance on Clinical Considerations," BNA Bloomberg Health Law Reporter, 2014
  • Co-author, "Practical Considerations for Providers Dealing With Ebola," BNA Bloomberg Health Law Reporter, 2014

Seminars

  • "Health Care Predictions – What Can Physicians Expect?" 2018
  • "Claims Appeals Developments and Proposals for Expansion," Webinar, 2016
  • "Beware of the ZPIC – Tips and Tactics from the Trenches," AHLA Webinar, 2011 and 2013
  • "Medical Necessity Appeals in Long Term Care," New England Health Information Management Association Annual Meeting, 2012
  • "Claims Appeals Fundamentals," American Health Lawyers Association Annual Medicare and Medicaid Institute, Baltimore, 2012

Memberships And Affiliations

  • American Health Lawyers Association
  • DC Bar Association, Health Law Section
  • American Bar Association, Health Law Section

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