Ryan L. Torres, Associate

Provider Appeals

Ryan represents a variety of healthcare clients in Medicare, Medicaid, and Managed care administrative appeals. He has a deep understanding of the appeal process, having represented the Indiana Medicaid in over 160 provider appeals taken after adverse agency action, including from overpayment determinations, Surveillance Utilization Review and Long Term Care audits, pharmacy audits, rate setting determinations, provider enrollment denials/terminations, Credible Allegation of Fraud findings, reimbursement disputes, provider prior authorization and medical necessity determinations, penalties, and supplemental payment and NSGO status determinations.

Ryan’s experience litigating administrative appeals encompasses preliminary determinations leading up to the appeal, the appeal process, and on judicial review. He understands how providers are chosen by the state for scrutiny, the conduct that may render them a target of an audit, and how to leverage sampling and extrapolation in support of a client’s position. His experience allows him to provide practical guidance to help his clients understand their circumstances and the likely outcome of any given dispute. Reimbursement disputes, including audits – regardless of whether the dispute involves Medicare, Medicaid, Managed Care in Medicare or Medicaid, or commercial payer – are extremely complex and oftentimes involve significant dollars. Ryan has dealt with such disputes on a daily basis and can help resolve yours.

If an agency has acted in such a way as to negatively impact you or your organization, please contact Ryan immediately, as you have limited time to contest it.