David J. Vernon

David Vernon helps providers navigate the complex and multi-layered Medicare and Medicaid reimbursement landscape.  His deep regulatory knowledge, his experience in reimbursement matters generally, and extensive work on Graduate Medical Education reimbursement issues in particular, and his appreciation of the operational and occupational challenges providers face, have allowed David to successfully advise clients on agency requirements and favorably resolve numerous reimbursement disputes for providers across the country.

A widely recognized licensure and certification expert, David also advises clients on complex regulatory issues that arise in the context of mergers, acquisitions, reorganizations, and related transactions.  He assists clients with a broad range of licensing and certification, fraud and abuse, and compliance matters, developing effective strategies and practical solutions based on his understanding of how both regulators and providers go about their work. He quickly identifies issues and potential areas of concern before they metastasize into costly and disruptive problems.

David has cultivated productive relationships with State and Federal regulators, which allows him to diffuse contentious disagreements and facilitate efficient resolutions for his clients. He has achieved numerous successful outcomes in licensure, certification, compliance, and reimbursement matters or appeals, including those involving provider certification, Medicare Area Wage Index and rural floor issues, and Graduate Medical Education reimbursement. David is one of only a handful of attorneys in the United States with substantial experience in Graduate Medical Education reimbursement matters, making him a sought-after resource for teaching hospitals requiring seasoned counsel for their unique needs.

David’s health care experience and work with teaching hospitals predate his legal career. Prior to law school, he worked as the research analyst to the President and CEO of the Association of American Medical Colleges, and has published several articles in peer-reviewed biomedical journals. While earning his law degree, David was co-president of the Healthcare & Biotech Law Society and worked as a research assistant for the Warren Institute’s Health, Economic & Family Security Program on legal issues impacting the creation of safety-net Accountable Care Organizations.

Representative Experience

• Advising health care providers on various reimbursement issues under the Medicare and Medicaid programs, including GME, area wage index, rural floor, and allied health.
• Assisting health care providers, including hospitals, skilled nursing facilities, clinics, home health agencies, hospices, ambulances, and residential care facilities for the elderly with regulatory compliance, licensure and certification, payment, and operational issues.
• Assisting health care clients in addressing complex regulatory issues that arise in the context of mergers, acquisitions, reorganizations and related transactions.
• Advocating for appropriate medical education reimbursement through PRRB appeals and/or other regulator communication.
• Drafting GME affiliation agreements, resident and medical student rotation agreements, and resident employment agreements.
• Prosecuting multiple hospital group appeals, before CMS and in federal court, seeking hundreds of millions of dollars in Medicare payments related to area wage index and rural floor policy changes.