Photo of Kenneth R. MarcusPhoto of Kenneth R. Marcus

Kenneth R. Marcus

Partner

Education

Wayne State University Law School, J.D.
  • magna cum laude; Order of the Coif
University of Michigan, M.H.S.A.
Stony Brook University, B.A.

Prior Employment

  • Kenneth R. Marcus, P.C., 1996-2005
  • Honigman Miller Schwartz and Cohn LLP, Partner, 1984-1995

Bar Admissions

Court Admissions

Professional Affiliations

Healthcare Financial Management Association, Eastern Michigan Chapter

  • Board of Directors, Past Member
  • Compliance Committee

    • Founder
    • Inaugural Chair
  • Advanced Member

  • Recipient of Bronze, Silver, Gold, Laetz and Medal of Honor awards

Michigan Society of Healthcare Attorneys

Health Care Compliance Association

State Bar of Michigan

  • Health Law Section

BNA's Medicare Reporter

  • Advisory Board

American Health Lawyers Association

  • Reimbursement, Accreditation and Payment Practice Group, Past Vice Chair
  • Lifetime Members Council
    • Steering Committee, Chair
    • Community, Moderator

American Bar Association

  • Payment and Reimbursement Interest Group, Past Chair

Michigan Health and Hospital Association

  • Small or Rural Hospital Council

University of Michigan School of Public Health

  • Alumni Board of Governors, Past Member
  • Alumni Board Department of Health Management and Policy, Past Member
Overview
Experience
News & Resources
Honors

Overview

Mr. Marcus is nationally recognized in hospital Medicare and Medicaid payment appeal issues with nearly three decades of successful representation of numerous hospitals in individual and group appeals before the Provider Reimbursement Review Board, the federal district courts and federal courts of appeals. 

  • Substantial experience as a transactional lawyer as a result of representing clients in major business transactions such as establishment of health systems, hospital mergers, managed care contracting, integrated delivery system development, hospital-physician joint ventures, hospital physician practice acquisitions and physician contracting
  • Frequently advises clients in matters involving the Medicare and Medicaid Anti-fraud and Abuse Provisions, the Stark Act, and the Federal False Claims Act, including representation of clients accused of violating these laws and consultation regarding business arrangements potentially exposed to liability under these laws
  • Services to clients in the health field include the following areas of law:
    • Administrative and regulatory advice and representation before state and federal agencies, including the Department of Health and Human Services, and the Centers for Medicare and Medicaid Services
    • Third-party payor appeals before the Provider Reimbursement Review Board and the federal courts
    • Third-party payor audits
    • Business enterprise formation and contractual documentation
    • Hospital physician transactions/relationships
    • Provision of fraud, illegal remuneration, False Claims Act and "Stark" advice and defense
    • Assistance in managed care organization development and operational advice, documentation and representation
    • Assistance and representation in licensure and certification and certificate of need
    • Merger, acquisition, joint venture and partnership advice and representation

Experience

  • Appointed by Court along with three national law firms to serve on the Plaintiffs’ Coordinating Counsel in national Medicare disproportionate share hospital litigation involving more than 600 hospitals and resulting in $662 million recovery; In Re Medicare Reimbursement Litigation Baystate Health Systems v. Leavitt, 414 F.3d 7 (D.C. Cir. 2005)
  • Hospital’s self-disallowance of inclusion of Medicaid eligible days for purposes of disproportionate share hospital adjustment computation remanded to agency in client's favor; The Norwalk Hospital Association v. Sebelius, No. 12-01065 (D. Conn.)
  • Recoveries in cases brought to federal court include:
    • University of Michigan Hospital et. al v. Heckler (6th Circuit)
    • Detroit Receiving Hospital v. Shalala (6th Circuit)
    • Hurley Medical Center v. Shalala (E.D. Michigan)
    • Stormont-Vail Regional Medical Center v Shalala, 708 F.Supp.2d 1178 (D. Kansas 2010)
    • Oakwood Annapolis Hospital et. al v. Sebelius, 08-14939 (E.D. Michigan, settled 2010)
    • Glendale Memorial Hospital et. al v. Sebelius, 09-0637 (D.C.D., settled in clients’ favor 2011)
    • Hurley Medical Center v. Sebelius, 10-15057 (E.D. Michigan, settled in client’s favor 2011)
    • E.W. Sparrow Hospital v. Leavitt, 08-1021 (D.C.D, settled in client’s favor on remand 2012)
    • St. Joseph Mercy Hospital Oakland v. Leavitt, 10-2070 (D.C.D., settled in client’s favor 2012)
    • Bethesda Memorial Hospital v. Sebelius, 11-80201 (S.D. Fla., remand to PRRB in client’s favor 2012)
    • Glendale Memorial Hospital et. al v. Sebelius, 08-1747 (C.D. Cal., settled in clients’ favor 2012)
    • St. Francis Memorial Hospital and Davies Medical Center v. Sebelius, 08-1440 (N.D. Cal., settled in clients’ favor 2012)
  • Defended Medicaid and Blue Cross/Blue Shield audits successfully
  • Frequently called upon by clients to provide payment planning advice in the transactional context                                   
  • Played lead corporate counsel role in the formation of, and served as general counsel to, two Managers of Comprehensive Provider Network serving persons with developmental disability and severe mental illness in Wayne County
  • Served as a member of the American Bar Association Health Section Task Force that submitted comments to the Secretary of the Department of Health and Human Services regarding substantially revised 2008 rules governing the Medicare appeals and reopening process

News & Resources

News

Press Releases

Publications

Seminars & Events

Honors

  • State Bar of Michigan Health Care Law Section, Fellow, 2014-present
  • The Best Lawyers in America, 2008-2017
  • DBusiness, Top Lawyers, 2010, 2011, 2013-2016
  • Michigan Super Lawyers, 2007-2016
  • Martindale-Hubbell AV® Preeminent™ Peer Review Rated
  • Recipient of Health Care Financial Management Association - Gold, Silver and Bronze Certificate, National Yeager Award, Outstanding Committee Chair Award and 2003 Ernest Laetz Award
  • Recipient of Founders Medal of Honor, Eastern Michigan Chapter of Healthcare Financial Management Association