Kelly A. Carroll

Kelly Carroll represents hospitals, physicians, long-term care facilities, and other providers in reimbursement disputes before the Provider Reimbursement Review Board and in federal and state courts.  She has a deep understanding of the complex Medicare and Medicaid reimbursement landscape and has helped to secure or recover millions of dollars in payments for health care providers. 

Kelly advises clients on all aspects of the reimbursement cycle ranging from initial rulemaking to conclusive appeals. She also advises health care providers and state agencies on matters involving federal funding of state health care programs and disputes with the Centers for Medicare & Medicaid Services (CMS). 

In addition to her reimbursement and compliance work, Kelly also leverages her academic and professional background in medical ethics to provide guidance on legal and ethical issues relating to informed consent and clinical research.

Prior to her legal career, Kelly conducted NIH-funded bioethics research at the University of Pennsylvania and Saint Louis University, and she was awarded a fellowship at the Institute for Ethics of the American Medical Association. Kelly also served as the Executive Managing Editor of The American Journal of Bioethics.

Representative Experience

• Served as co-counsel for hundreds of hospitals in federal litigation and drafted trade association comments resulting in invalidation and withdrawal of the 0.2 percent reduction to Medicare hospital payment rates made by the Secretary of Health and Human Services in connection with the “Two-Midnight Rule.”
• Represented Medicaid agency in disallowance appeals against CMS before the Departmental Appeals Board, successfully negotiating settlement.
• Served as co-counsel to hospitals before state administrative courts and in federal court challenging Medicaid DSH repayment demands predicated on CMS guidance promulgated in a frequently-asked-questions document. Federal courts found CMS’s FAQ guidance invalid and the agency revoked the guidance document.
• Currently representing hundreds of hospitals in appeals before the Provider Reimbursement Review Board and in federal court on a wide range of Medicare reimbursement issues, including DSH payments, wage index, GME, outlier payments, and standardized amount reductions.
• Successfully defended hospitals in False Claims Act litigation, securing dismissals.
• Represented Critical Access Hospital in a novel Medicare reimbursement dispute before a federal appeals court.