Kimberly A. Lammers

Kimberly A. Lammers provides legal advice and assistance to a broad range of health care clients, including multi-state health systems, academic medical centers, community hospitals, critical access hospitals, independent laboratories, imaging centers, ambulatory surgery centers, behavioral health providers ranging from community mental health providers to inpatient psychiatric units, federally qualified health centers (“FQHCs”), home health and hospice providers, therapy providers, physician practices, durable medical equipment suppliers, pharmacies, nursing homes and assisted living facilities, telehealth providers, and specialty providers, including organizations that furnish home-delivered meal services, transition of care services, and remote patient monitoring services. Kim has a wealth of practical health care experience, having practiced in the area of health care law exclusively over her twenty-year career, including spending over a decade working in-house for a large health system in the areas of legal, compliance, and revenue cycle. She has expertise in a wide range of operational issues for health care providers and enjoys assisting clients in achieving their objectives and goals in a collaborative way while also minimizing legal and compliance risks.

Kim specializes in regulatory compliance matters, including Medicare and Medicaid reimbursement issues, Federal health care program fraud and abuse laws including Stark Law and Anti-Kickback Statute compliance, and state health care law issues. She has expertise in preparing corrective action plans to address survey deficiencies issued by the Centers for Medicare and Medicaid Services (“CMS”), Clinical Laboratory Improvement Amendments (“CLIA”) surveyors, or accreditation agencies; providing advice regarding residency programs and graduate medical education program funding; creating compliance policies and processes, including policies for billing compliance and clinical documentation improvement programs; conducting compliance program effectiveness evaluations; managing peer review and risk management issues; counseling providers regarding medical staff bylaws and performance improvement and disciplinary actions; and addressing credentialing and medical staff issues relating to the use of telehealth providers, including e-stroke, e-hospitalist, and e-ICU providers.

She also assists clients with responding to governmental investigations; making self-disclosures and refunding potential overpayments; responding to requests for recoupments and repayments from governmental contractors and the integrity units of third-party payors; appealing adverse payment, reimbursement, and enrollment determinations, including to the Administrative Law Judge, Departmental Appeals Board, and Provider Reimbursement Review Board levels; and responding to allegations of fraudulent billing, the provision of medically unnecessary services, or failure to meet regulatory standards from CMS, the Office of Inspector General, state Medicaid agencies, state Attorneys’ General offices, and state Medicaid Fraud Control Units. She prepares and negotiates contracts for all types of services and operational functions, including coding, billing, medical records, and other “back room” health care provider functions; clinical and professional services agreements; physician and non-physician practitioner employment agreements; hospital-based physician services agreements; and managed care health plan arrangements, including Medicare Advantage, Medicaid managed care, and other governmental payor programs. Most recently, Kim has assisted clients in responding to the public health emergency caused by the spread of SARS-CoV-2, the novel coronavirus that causes COVID-19, including implementing of blanket federal and state waivers, developing requests for approvals of additional provider-specific waivers, advising regarding state licensure laws, interpreting the rapidly changing telehealth coding and reimbursement guidance, and applying for CLIA certifications for new COVID testing programs.

Kim is licensed in Iowa, Nebraska, South Dakota, and Wisconsin. She is also a Certified Professional Coder through the American Academy of Professional Coders (“AAPC”) and has completed ICD-10 proficiency testing. She is a member of the Iowa State Bar Association, Nebraska State Bar Association, South Dakota State Bar Association, Wisconsin State Bar Association, Omaha Bar Association, American Health Law Association, Health Care Compliance Association, Nebraska Healthcare Financial Management Association, and the Iowa Society of Healthcare Attorneys.

Kim received her law degree from Creighton University School of Law, summa cum laude, and received her undergraduate degree from the University of South Dakota, magna cum laude, with University honors.