Judith (Judy) A. Waltz is a health care partner with Foley & Lardner LLP. Her practice focuses on government investigations, false claims acts, corporate integrity agreements (CIAs), reimbursement strategies, bankruptcy, Medicare and Medicaid compliance counseling, and Medicare/Medicaid overpayments and enrollment disputes. Judith works with clients in various areas of the health care industry. She is the chair of the firm’s Health Care Practice Group and co-chair of the Health Care & Life Sciences Sector’s Providers of Health Care Services Area of Focus. Judith is also a member of the Government Enforcement Defense & Investigations and Bankruptcy & Business Reorganizations Practices.
Fraud and Abuse, FCA and Health Care Fraud Investigations
Judith regularly advises clients who are the focus of government investigations and other enforcement actions and has negotiated false claims act settlements with the U.S. Department of Justice as well as corporate integrity agreements (CIAs) with the Office of Inspector General. She then has worked closely with those clients to implement their CIAs, including ongoing advice in connection with IRO audits and reviews. At the state level, she has been involved with various Medi-Cal audits, payment suspensions, and investigations, including a matter involving allegations of inflated drug pricing by a major pharmaceutical company.
Medicare and Medicaid
Judith also provides ongoing compliance counseling and Medicare and Medicaid payment advice to clients, which include hospices, large physician practices, county health systems, hospitals, durable medical equipment suppliers, clinical laboratories, dialysis companies, skilled nursing facilities, ambulance companies, pharmacies, managed care providers, and a variety of other health care entities. In 2013, she served as special Medicare counsel in the bankruptcy of San Diego Hospice, a large not-for-profit entity. Judith has advised clients (including physician practices, hospices, and hospitals) undergoing UPIC, ZPIC, RAC audits, other Medicare or Medicaid audits, overpayments, and pre-pay reviews. She is experienced in Medicare and Medi-Cal provider enrollment appeals and Medicare billing number revocations and other enforcement actions.
Prior to joining the firm in 1998, Judith served as assistant regional counsel for the U.S. Department of Health and Human Services in San Francisco, primarily handling Medicare issues including survey and certification and various types of reimbursement disputes. In that position, she appeared frequently before the Ninth Circuit and other federal courts in matters primarily involving payment disputes (including PRRB appeals), bankruptcy issues, and Medicare Secondary Payer (MSP) disputes. She held collateral appointments as a special assistant United States attorney for the Eastern and Northern districts of California.
Health Care Litigation
As assistant regional counsel for the Department of Health and Human Services for 12 years, Judith represented the secretary in the Ninth Circuit and other federal courts in matters primarily relating to disputes regarding Medicare payments to providers and suppliers. These cases included several court appeals of Provider Reimbursement Review Board decisions involving Medicare cost reports. In the bankruptcy and district courts, she represented the Department of Health and Health and Human Services in a precedential case, In re TLC Hospitals, Inc., later decided by the 9th Circuit in 224 F.3d 1008 (9th Cir. 2000), upholding Medicare’s ability to recoup pre-petition overpayments from post-petition overpayments. She also represented the government in various bankruptcy court actions involving the assumption of the Medicare provider agreement as an executory contract, a debtor’s challenge to a hospital decertification action taken post-petition, and post-petition payment suspension actions. As an additional part of her government representation, she served as primary counsel in various proceedings involving the Medicare Secondary Payer (MSP) provisions. Judith has represented providers and suppliers who are under investigation relating to their participation in the Medicare and Medi-Cal programs, including negotiating settlements and corporate integrity agreements relating to issues including hospice admissions, clinical laboratory claims, partial hospitalization services, inpatient short stays, costs claimed on cost reports, oxygen (DME) billing, and assorted allegations of upcoding. She also served as lead counsel in an administrative appeal of the imposition of a Medi-Cal civil money penalty. She has appeared in several administrative appeals before the federal HHS Departmental Appeals Board, including decertification actions taken under the Clinical Laboratory Improvement Act (CLIA), civil monetary penalties and adverse enrollment actions, and in overpayment appeals heard by the Office of Medicare Hearings and Appeals. In addition, she has represented providers and suppliers in the OIG’s Self-Disclosure Protocol, and in CMS’s Self-Disclosure Referral Protocol.
Telemedicine Experience
Judith has advised on compliance and reimbursement issues relating to business structures for providing telemedicine, requirements of the Medicare Conditions of Participation for hospitals that are participating in telemedicine services, applicable Medicare and Medicaid enrollment issues for telemedicine providers, and operational issues such as supervision of non-physician practitioners across sites. She has also worked extensively with the Clinical Laboratory Improvement Act (CLIA), payer, and compliance requirements regarding laboratory verbal and electronic orders and results.
