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Mark Polston assists health care systems navigate the Medicare regulatory world. As the former Chief Litigation counsel for the Centers for Medicare & Medicaid Services, Mark has decades of experience in Medicare reimbursement policy and Medicare fraud defense. As a partner in our Healthcare practice, Mark advises healthcare providers on Medicare reimbursement strategy, advises clients on complying with regulatory requirements, represents hospitals in Medicare reimbursement litigation and defends providers against government enforcement actions.

For more than 20 years, Mark has counseled clients in the complex world of the Medicare program, a regulatory environment so intricate that the Supreme Court has described it as "unintelligible to the uninitiated." In that vein, Mark specializes in complicated Medicare reimbursement litigation, including the successful challenge to Medicare's so-called "Two Midnight" 0.2 percent rate cut. As a former high-ranking attorney within the Department of Health and Human Services, Mark brings credibility and an insider's knowledge when advocating before CMS and Congress on Medicare and Medicaid issues.

Drawing upon his experience as CMS's former chief litigation counsel, Mark represents hundreds of hospitals in Medicare reimbursement appeals. His cases typically challenge national Medicare reimbursement policies with hundreds of millions of dollars at stake. On the defense side, Mark's years of government fraud enforcement experience and Medicare knowledge translates to surgically effective representation of providers in Medicare fraud investigations.

More than just a litigator, Mark's years-long experience with Medicare and Medicaid means that he possesses a deep and wide body of knowledge about these programs which allows him to counsel and strategize with clients on diverse topics such as Graduate Medical Education reimbursement for teaching hospitals, Medicare's "provider-based" rules, and Medicare coverage standards for inpatient services.

With all of this experience, Mark has become a nationally-recognized expert on Medicare reimbursement and speaks annually at the Medicare and Medicaid Payment Institute sponsored by the American Healthcare Lawyers' Association. Mark is also a co-editor of the Reimbursement Advisor.

Full Bio

Credentials

J.D., Harvard Law School, cum laude

B.A. Political Science, University of Dayton, summa cum laude

California

District of Columbia

Maryland

Supreme Court of the United States

U.S. Court of Appeals for the D.C. Circuit

U.S. Court of Appeals for the Ninth Circuit

Law Clerk, Pierce Lively, U.S. Court of Appeals for the Sixth Circuit

Sources praise his ability to "distill issues carefully and thoughtfully," while also praising his "very client service-oriented" approach.


Chambers 2017 Healthcare

Named a "Life Sciences Star"


LMG Life Sciences, 2016

Ranked in the Healthcare: Service Providers category


The Legal 500, 2015

Received the Superior Achievement Award


HHS, Office of General Counsel

Received the Special Service Citation


CMS Administrator

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Recognition

Sources praise his ability to "distill issues carefully and thoughtfully," while also praising his "very client service-oriented" approach.


Chambers 2017 Healthcare

Named a "Life Sciences Star"


LMG Life Sciences, 2016

Ranked in the Healthcare: Service Providers category


The Legal 500, 2015

Received the Superior Achievement Award


HHS, Office of General Counsel

Received the Special Service Citation


CMS Administrator

Matters

"Represented over 200 hospitals in a successful lawsuit challenging CMS's decision to cut inpatient Medicare hospital rates to offset the financial impact of the so-called Two Midnight rule, leading to a reversal of the policy by CMS and an influx of approximately $660 million in additional Medicare reimbursement to the nation's acute care hospitals."

"Won an $18 million arbitration award for a national healthcare company involving breach of contract and fraud claims against sellers of a Medicare-reimbursed hospice."

"Spearheaded the RAC Coalition, a group of the nation's leading hospitals which successfully lobbied for reform of the Medicare Recovery Audit Contractor program."

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Matters

"Represented over 200 hospitals in a successful lawsuit challenging CMS's decision to cut inpatient Medicare hospital rates to offset the financial impact of the so-called Two Midnight rule, leading to a reversal of the policy by CMS and an influx of approximately $660 million in additional Medicare reimbursement to the nation's acute care hospitals."

"Won an $18 million arbitration award for a national healthcare company involving breach of contract and fraud claims against sellers of a Medicare-reimbursed hospice."

"Spearheaded the RAC Coalition, a group of the nation's leading hospitals which successfully lobbied for reform of the Medicare Recovery Audit Contractor program."

"Leading the Stark Reform Coalition, a consortium of hospitals seeking reform of the Stark Physician Self Referral Law."

"Representing an academic medical center in a False Claims Act investigation involving allegations of violations of the Medicare provider-based facility rule."

"Representing Community Health Systems in numerous cost report reimbursement appeals before the Provider Reimbursement Review Board and in federal court."

"Representing the Florida Hospital Association and several Florida hospitals in multi-million dollar group appeal challenge to CMS policy excluding Low Income Pool Section 1115 expansion waiver days from the Medicare DSH payment calculation."

"Counseled major Mid-Western hospital chain on reorganization of its Medicare Graduate Medical Education programs, including seeking rural re-designation of certain hospitals in order to maximize FTE 'cap space' and take advantage of relaxed rules for creation of 'new' medical education programs, all of which resulted in millions of dollars of additional Medicare reimbursement."

"Successfully assisted academic medical center in seeking 'on-campus' status from CMS for provider-based facility located more than 250 yards from campus, resulting in millions of dollars of additional Medicare reimbursement."

"Counseled numerous providers on the 60-day overpayment rule, including advising a hospice provider in identifying and returning a $10 million overpayment refund to the Medicare program."

"Representing 30 hospitals in a multi-million dollar challenge to CMS regulation which arbitrarily penalizes teaching hospitals for training medical fellows above their 'FTE cap.'"

Matters

"Represented over 200 hospitals in a successful lawsuit challenging CMS's decision to cut inpatient Medicare hospital rates to offset the financial impact of the so-called Two Midnight rule, leading to a reversal of the policy by CMS and an influx of approximately $660 million in additional Medicare reimbursement to the nation's acute care hospitals."

"Won an $18 million arbitration award for a national healthcare company involving breach of contract and fraud claims against sellers of a Medicare-reimbursed hospice."

"Spearheaded the RAC Coalition, a group of the nation's leading hospitals which successfully lobbied for reform of the Medicare Recovery Audit Contractor program."

See more
Icon close

Close

Matters

"Represented over 200 hospitals in a successful lawsuit challenging CMS's decision to cut inpatient Medicare hospital rates to offset the financial impact of the so-called Two Midnight rule, leading to a reversal of the policy by CMS and an influx of approximately $660 million in additional Medicare reimbursement to the nation's acute care hospitals."

"Won an $18 million arbitration award for a national healthcare company involving breach of contract and fraud claims against sellers of a Medicare-reimbursed hospice."

"Spearheaded the RAC Coalition, a group of the nation's leading hospitals which successfully lobbied for reform of the Medicare Recovery Audit Contractor program."

"Leading the Stark Reform Coalition, a consortium of hospitals seeking reform of the Stark Physician Self Referral Law."

"Representing an academic medical center in a False Claims Act investigation involving allegations of violations of the Medicare provider-based facility rule."

"Representing Community Health Systems in numerous cost report reimbursement appeals before the Provider Reimbursement Review Board and in federal court."

"Representing the Florida Hospital Association and several Florida hospitals in multi-million dollar group appeal challenge to CMS policy excluding Low Income Pool Section 1115 expansion waiver days from the Medicare DSH payment calculation."

"Counseled major Mid-Western hospital chain on reorganization of its Medicare Graduate Medical Education programs, including seeking rural re-designation of certain hospitals in order to maximize FTE 'cap space' and take advantage of relaxed rules for creation of 'new' medical education programs, all of which resulted in millions of dollars of additional Medicare reimbursement."

"Successfully assisted academic medical center in seeking 'on-campus' status from CMS for provider-based facility located more than 250 yards from campus, resulting in millions of dollars of additional Medicare reimbursement."

"Counseled numerous providers on the 60-day overpayment rule, including advising a hospice provider in identifying and returning a $10 million overpayment refund to the Medicare program."

"Representing 30 hospitals in a multi-million dollar challenge to CMS regulation which arbitrarily penalizes teaching hospitals for training medical fellows above their 'FTE cap.'"

Credentials

J.D., Harvard Law School, cum laude

B.A. Political Science, University of Dayton, summa cum laude

California

District of Columbia

Maryland

Supreme Court of the United States

U.S. Court of Appeals for the D.C. Circuit

U.S. Court of Appeals for the Ninth Circuit

Law Clerk, Pierce Lively, U.S. Court of Appeals for the Sixth Circuit

Sources praise his ability to "distill issues carefully and thoughtfully," while also praising his "very client service-oriented" approach.


Chambers 2017 Healthcare

Named a "Life Sciences Star"


LMG Life Sciences, 2016

Ranked in the Healthcare: Service Providers category


The Legal 500, 2015

Received the Superior Achievement Award


HHS, Office of General Counsel

Received the Special Service Citation


CMS Administrator

Icon close

Close

Recognition

Sources praise his ability to "distill issues carefully and thoughtfully," while also praising his "very client service-oriented" approach.


Chambers 2017 Healthcare

Named a "Life Sciences Star"


LMG Life Sciences, 2016

Ranked in the Healthcare: Service Providers category


The Legal 500, 2015

Received the Superior Achievement Award


HHS, Office of General Counsel

Received the Special Service Citation


CMS Administrator