W. Jerad Rissler

Successfully represented a hospital in a state administrative appeal of an imposition of an excessive provider fee under Georgia’s Provider Payment Agreement Act.

Obtained numerous trial court orders compelling arbitration pursuant to pre-dispute arbitration agreements and successfully defended claims in arbitration.

Successfully challenged regulations implementing the Medicare hospice cap.

Achieved a favorable settlement (a fraction of the alleged single damages) of False Claims Act case involving the medical necessity of hospice services after forcing government to correct and clarify allegations in its Complaint in Intervention regarding physician certifications because the allegations were contradicted by the government’s own interview notes of the witness to whom the allegations were attributed. U.S. ex rel. Smith v. Serenity Hospice Care, LLC, 3:13-cv-00001-DHB-BKE (S.D. Ga. Oct. 6, 2014) (Notice of Correction and Clarification).

Demonstrated skilled nursing facility’s achievement of substantial compliance (and ability to maintain compliance) with Medicare’s conditions of participation and obtained a temporary restraining order in federal court halting termination of the facility’s Medicare and Medicaid provider agreement. The facts developed in connection with obtaining the TRO provided key support to a bankruptcy filing made during the pendency of the temporary restraining order that has successfully avoided termination of the provider agreements pending completion of the administrative appeals process.

Assisted in framing the arguments and preparing the briefs resulting in favorable appellate court opinions enforcing pre-dispute arbitration agreements entered in connection with nursing home admissions. Dean v. Heritage Healthcare of Ridgeway, LLC, 759 S.E.2d 727, 2014 WL 2771300 (S.C. June 18, 2014) (reversing 20-year precedent that nursing home contracts do not involve interstate commerce and finding that agreement could be enforced notwithstanding unavailability of AAA to administer arbitration); Estate of Daneshmayeh v. Heartland of Boynton Beach FL, LLC, 134 So.3d 470 (Fla. App. 2014) (decision without published opinion); Estate of Lewandowski v. Heartland of Boca Raton FL, LLC, 134 So.3d 470 (Fla. App. 2014) (decision without published opinion).

Implemented novel strategy of filing a federal lawsuit to successfully compel arbitration of a nursing home case resulting in a decision of first impression in Georgia. Kindred Nursing Centers Limited Partnership v. Cynthia Jones, Case No. CV409-105 (S.D. Ga. March 16, 2011).

Favorably resolved a high-profile federal False Claims Act case brought by the Department of Justice alleging that two national nursing home chains and their principals conspired to solicit a $50 million kickback from a large national pharmaceutical supply company in exchange for continuing to provide pharmacy services to the homes.

Obtained rulings from the North Carolina Court of Appeals and South Carolina Court of Appeals enforcing pre-dispute arbitration agreements entered in connection with nursing home admissions. Westmoreland v. High Point Healthcare Inc., 721 S.E.2d 712 (N.C. App. 2012) (holding that agreement was not unconscionable and enforcing agreement notwithstanding unavailability of AAA to administer arbitration); Johnson v. Heritage Healthcare of Estill, LLC, 2014-UP-318 (S.C. App. Aug. 6, 2014) (unpublished).

Successfully negotiated the resolution of claims for reimbursement of Medicare bad debts on behalf of a group of skilled nursing providers following an appeal to the U.S. Court of Appeals for the Eleventh Circuit.