10.22.26
Event Sponsor: Healthcare Financial Management Association
Borgata Casino and Spa
2:00 – 2:50pm
Greenbaum healthcare attorneys James A. Robertson and Paul L. Croce will present a breakout educational session on “The New World of Medicaid Appeals in the Age of Managed Care” at the New Jersey & Metro Philadelphia HFMA 50th Anniversary Annual Institute, which will be held at The Borgata Casino and Spa in Atlantic City from October 21, 2026 – October 23, 2026.
The session, scheduled for Thursday, October 22nd from 2:00 – 2:50pm in Ballroom 4, will explore the significant shift from beneficiaries enrolled in traditional Medicaid to those enrolled in Managed Medicaid over the past several decades. The New Jersey Division of Medical Assistance and Health Service (DMAHS) has indicated that as of October 2023, 97% of Medicaid/NJ Family Care beneficiaries participate in managed care plans.
Under traditional Medicaid, hospitals are not generally required to seek preauthorization for inpatient admissions but are subject to audits which can result in subsequently denied claims and recovery of overpayment. Conversely, the private companies offering Managed Medicaid generally require hospitals to obtain preauthorization for all inpatient admissions.
This program will explore the ongoing dispute between various New Jersey hospitals and DMAHS, regarding DMAHS’ authority to retroactively audit, and seek recoupment of alleged overpayments, on claims which were preauthorized by the Managed Care Organization (MCO). The discussion will address legal arguments raised by both DMAHS and the hospitals regarding such authority. The program will further explore areas of focus in these audits by DMAHS and its Utilization Review (UR) vendor Permedion.
Jim leads the firm’s healthcare practice, where his work spans the full spectrum of legal, regulatory, and corporate challenges facing healthcare entities. With a deep technical command of reimbursement and payer strategy, he regularly represents hospital systems and providers in high-stakes Medicare, Medicaid, and charity care subsidy matters. He has deep expertise in navigating disproportionate share hospital (DSH) and graduate medical education (GME) issues and ensures the long-term sustainability of provider-payer relationships by negotiating complex Medicare Advantage and Managed Medicaid risk-sharing arrangements.
As Counsel on the healthcare team, Paul has focused expertise in hospital reimbursement and guardianship matters. He represents hospitals and healthcare systems before the Department of Health and the Division of Medical Assistance and Health Services in Medicaid and Medicare appeals, Disproportionate Share Hospital (DSH) subsidy appeals, Graduate Medical Education (GME) subsidy appeals, and other legal challenges.
Greenbaum is pleased to be a sponsor of the 50th Anniversary Annual Institute and will be exhibiting at this year’s event. The conference agenda and registration details are available on the HFMA website.