Chris Keough is a partner in King & Spalding’s Healthcare Practice Group. His practice focuses on Medicare and Medicaid reimbursement and compliance. Mr. Keough regularly represents hospitals before the Provider Reimbursement Review Board and in the federal court in matters involving reimbursement for disproportionate share hospitals, prospective payment system rates, graduate medical education, and other payment issues. Mr. Keough also represents clients in administrative, civil, and criminal actions involving alleged false claims or fraud and abuse in federal health programs. The remainder of his practice consists of counseling with regard to federal health regulatory matters. He has been recognized in Chambers USA and The Best Lawyers in America in health law and is listed as a “Washington, D.C. Super Lawyer.”

Representative Experience

Medicare Reimbursement Litigation

• Obtained the first-ever decisions by the Provider Reimbursement Review Board and a federal district court requiring HHS to correct several systemic errors and omissions in the data and processes used to calculate the Medicare/SSI fractions that determine hospitals’ qualification for, and the amount of, Medicare DSH payments.



• Secured a key win in the lead case on the core issue involved in more than 270 consolidated suits involving more than 600 hospitals seeking additional DSH payment for eligible-but-unpaid Medicaid; obtained an order by the federal district court granting summary judgment for 27 hospitals represented in the lead case; successfully defended the judgment on appeal before the U.S. Court of Appeals for D.C. Circuit; and, successfully opposed the Solicitor General’s petition for review by the Supreme Court, notwithstanding the Government’s assertion of a circuit split on a nationally important issue involving as much as $2.8 billion in all of the consolidated actions combined. These decisions in the lead case paved the way for a global settlement involving payment of more than $660 million to the plaintiff hospitals in the consolidated litigation.



• Representing hospitals across the nation in challenges to the rural floor budget neutrality adjustment to the Medicare PPS payment rates.



• Representing a leading cancer hospital in appeals contesting the denial of adjustments to the TEFRA rate of increase ceiling.



• Representing hospitals in federal court action challenging the application of blended payment rates for hospital outpatient services



• Representing hospitals in a federal court action concerning Medicare reimbursement for premiums paid to an offshore captive insurer



• Successfully represented a hospital in a federal court suit seeking to incorporate the approval of a routine cost limit exception for a 1982 base year into the hospital-specific payment rate applicable to the four-year PPS transition period.



• Successfully represented a hospital in a federal court litigation seeking additional DSH payment pursuant to the hold-harmless provision established in CMS Program Memorandum A-99-62.



• Represented hospitals in several appeals concerning the count of full-time equivalent interns and residents for GME and IME, approved programs for IME and GME, payment for costs of residents’ training in unapproved programs, the average per resident amount for GME, and the bed count for IME.



• Obtained a federal court order requiring upward adjustment to the base-year average per resident used to calculate a teaching hospital’s GME payments for all years beginning on or after July 1, 1985.



• Successfully represented several sole community and Medicare-dependent hospitals in group appeals to the PRRB challenging the application of budget-neutrality update factors in the calculation of the hospital-specific payments due for several fiscal years



• Successfully represented more than 100 skilled nursing facilities in several group appeals overturning Medicare disallowances of allegedly excessive costs incurred for therapy services furnished under arrangements with outside contractors; reported court decisions.



• Successfully represented a rehabilitation agency in a federal court suit seeking reimbursement for the full amount of a lower-of-cost charges carryover, plus interest that had been denied due to an intervening change of ownership.



• Successfully represented several home health agencies in appeals from Medicare disallowances of management fees paid to a franchiser; reported decisions.

Case Citations (as lead counsel)

• BaystateMedicalCenter v. Leavitt, 545 F.Supp.2d 20 (DDC 2008).



• In Re Medicare Reimbursement Litigation, Baystate Health System et al. v. Thompson, 309 F.Supp.2d 89 (D.D.C. 2004), aff’d, 414 F.3d 7 (D.C. Cir. 2005), cert. denied, 126 S.Ct. 1672 (2006).



• Abbott-NorthwesternHospital v. Leavitt, 377 F.Supp.2d 119 (D.D.C. 2005).



• St. Joseph’s Hospital v. Leavitt, 425 F.Supp2d 94 (D.D.C. 2006).



• Inova Health System Foundation v. Thompson, Civ. Action No. 00-1862 (D.D.C. Aug. 15, 2002).



• GranCare, Inc. v. Shalala, 93 F.Supp.2d 24 (D.D.C. 2000).



• Eagle Healthcare, Inc. v. Shalala, 52 F.Supp.2d 1 (D.D.C. 1999).



• Interim Healthcare of New Haven v. Blue Cross Blue Shield Ass’n/Associated Hosp. Srvs. of Maine, PRRB Hearing Dec. No. 2000-D1, Medicare & Medicaid Guide (CCH) ¶ 80, 341 (Oct. 14, 1999) (Adm’r review declined); Interim Healthcare of Kansas City v. Blue Cross Blue Shield Ass’n/Cahaba Government Benefits Administrators, PRRB Hearing Dec. No. 2001-D18, Medicare & Medicaid Guide (CCH) ¶ 80,655 (Apr. 17, 2001) (Adm’r review declined).

Medicaid Reimbursement

• Successfully defended appeal to the U.S. Court of Appeals for the D.C. Circuit from district court order requiring payment of additional Medicaid disproportionate share hospital payments.



• Represented a state university-affiliated teaching hospital in connection with determination of uncompensated care cost limit on federal matching payment for Medicaid DSH payments declined.

Case Citations (as lead counsel)

• District of ColumbiaHospital Association et al. v. District of Columbia, 224 F.3d 776 (D.C. Cir 2000).

Compliance/Fraud & Abuse

• Assisted in defense of a major accounting firm in civil action brought under the False Claims Act with the respect to laboratory claims submitted by and paid to hospitals.



• Assisted as regulatory counsel in successful defense of a home health agency in criminal action alleging health care fraud with respect to Medicare cost report claims.



• Successfully represented Medicare provider in OIG investigation concerning potential administrative action relating to alleged false claims in Medicare cost reports and billing.

Counseling on Regulatory Matters

• Advised major national trade associations with respect to comments on proposed rules regarding substantially excessive charges, the Medicare DSH payment, and the application of the “anti-redistribution” principle in the determining the count of full-time equivalent residents for GME.

Memberships

• Healthcare Financial Management Association, VA/DC Chapter



• American Health Lawyers Association



• American Bar Association

Awards & Recognition

• Chambers USA: America’s Leading Business Lawyers in health care, 2008



• The Best Lawyers in America in health care law, 2005 to present



• Who's Who in American Law, 2007 to present



• "Washington, D.C. Super Lawyer," Washington, D.C. Super Lawyers, 2007 to present



• One of 12 outstanding healthcare litigators, Nightingale’s Healthcare News, 2004 and 2007



• HFMA Best Article Award for outstanding contributions to the professional literature, Healthcare Financial Management, 2004-2005



• Follmer Bronze Merit Award for Outstanding Service to HFMA, 2007



• Former Advisory Board Member, Bureau of National Affairs, Medicare Reporter