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

Law360 Healthcare Editorial Advisory Board

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

Kenneth R. Marcus has practiced exclusively health care law for 35 years, with extensive experience in corporate, payment, regulatory and compliance matters:

  • Recognized as a national expert in Medicare provider appeals procedure, with extensive experience representing hospitals before the Provider Reimbursement Review Board and the federal courts
  • 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 (Medicaid, Blue Cross Blue Shield, Commercial Insurer)
    • 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
    • Certificate of need and enrollment certification in Medicare and Medicaid

Experience

  • Established and represented two managed care organizations providing services to Medicaid eligible persons with behavioral health, developmental disability and severe mental illness in Wayne County
  • Recovered hundreds of millions of dollars in Medicare payment for hospitals nationwide through the appeals process at the Provider Reimbursement Review Board and the federal courts.
  • Furnished sophisticated anti-kickback, Stark and compliance guidance
    • Authored requests for Office of Inspector General Advisory Opinions
  • Defended professionals and organizations in audits conducted by Medicaid and Blue Cross Blue Shield
  • Structured hospital – physician alignment transactions
  • Conducted hospital joint venture and affiliation transactions
  • Resolved licensure, certificate of need and certification problems
  • Established and represented managed care organizations
  • Negotiated payor contracts with insurers, Blue Cross / Blue Shield and managed care organizations
  • Defended individuals in licensure and certification actions
  • Collaborated extensively with in house corporate counsel

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, 2008-2020
    • Recognized in practice area of Health Care Law
  • Michigan Super Lawyers, 2007-2018
  • Leading Lawyers Magazine Michigan, 2017
    • Recognized in practice areas of:
      • Civil Appellate Law
      • Commercial Litigation
      • Health Law
  • DBusiness, Top Lawyers, 2010, 2011, 2013-2017
  • 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

Academic Appointments

University of Michigan School of Public Health, Department of Health Management and Policy (HMP), Lecturer, 2019