Paul L. Garcia

With diverse industry experience and a commitment to his clients, Paul Garcia represents providers and clinical laboratories across the country in a wide variety of reimbursement, regulatory, compliance, and litigation matters. He protects and advocates for his clients by leveraging a deep knowledge of government health care programs, an understanding of how regulators operate, and an appreciation of how the letter of the law intersects with business and financial realities.

Paul’s clients include hospital associations, hospital systems, individual hospitals, and clinical laboratories that turn to him when facing complex or contentious reimbursement issues. Underlying all of Paul’s efforts is his recognition that disputes, or bureaucratic delays, can severely impair his clients’ ability to serve their patients and meet legal and ethical obligations. 

Leveraging his background working for the government on health care reimbursement and financing matters, Paul has productive relationships with government regulators, counsel, and staff, which facilitates him finding creative and practical resolutions for disputes with government payors. This has allowed Paul to help clients with a wide array of reimbursement matters.

Paul also assists providers and clinical laboratories with Medicaid reimbursement and Medicare claims disputes, audits, and investigations. During the COVID-19 pandemic, Paul’s reimbursement acumen helped guide clients through a rapidly evolving testing and payment landscape.  

Paul also works closely with clients on internal investigations of potential overpayments, providing actionable counsel regarding subsequent obligations to report and return under the 60-Day Rule. He regularly advises clients regarding compliance programs, policies, and practices to keep providers and clinical laboratories from making costly mistakes or oversights that could draw scrutiny from the government. 

Paul began his legal career with the California Department of Health Care Services, which administers California’s Medicaid program, Medi-Cal. There, he provided legal counsel to develop and support Medi-Cal managed care financing and reimbursement policy, including the department’s implementation of the 2016 Medicaid Managed Care Final Rule as it relates key reimbursement programs and directed-payment arrangements. In addition, Paul previously served as an Executive Fellow through the Capital Fellows Programs for Covered California, where he worked with the executive staff to implement state and federal health care reforms.

Representative Matters

• Negotiated settlement with DHCS on behalf of major hospital system regarding 8-figure audit dispute. 
• Negotiated global settlement with Medicare Administrative Contractor on behalf of multiple clinical laboratories regarding 7-figure overpayment assessment related to laboratory panels.  
• Second-chaired a 5-day hearing involving 1002 pharmacy claims, securing a favorable decision regarding all but 14 claims. 
• Many other successful settlement negotiations with State Medicaid programs and Medicare. 
• Successfully represented numerous clinical laboratories in Medicare claims disputes.