Overview

Kenneth R. Marcus has practiced exclusively health care law for 38 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

Services

Experience

Representative Matters

  • 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

Prior Experience

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

Academic Appointments

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

Credentials

Education

Admissions

Court Admissions

Recognition

Awards

  • State Bar of Michigan Health Care Law Section, Fellow, 2014-present
  • The Best Lawyers in America, 2008-2022
    • Recognized in practice area of Health Care Law
    • Detroit Health Care Law "Lawyer of the Year," 2021
  • 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

Professional & Community Involvement

  • 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
  • Elected to the 2023 Fellows Class of the American Health Law Association (AHLA)
  • 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

News & Insights

News

Press Releases

Publications

Alerts

Seminars & Events

  • Event | | | Presenter
  • Event | | | Co-presenter
  • American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, “It Don’t Mean A Thing If It Ain’t Got Jurisdiction”
    Event | March 20 and 21, 2019
  • Eastern Michigan Chapter, Healthcare Financial Management Association, “Topics In Medicare Part A Appeals That All Reimbursement Managers Should Know"
    Event |
  • The PRRB Rules 2.0 and Electronic Filing System
    Event | | | Presenter
  • Michigan Hospital Opportunity to Challenge Medicare Inpatient Prospective Payment System Standardized Amount
    Event | | Presenter
  • American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, “It Don’t Mean A Thing If It Ain’t Got Jurisdiction”
    Event | March 22 and 23, 2018
  • American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, “It Don’t Mean A Thing If It Ain’t Got Jurisdiction”
    Event | March 30 and 31, 2017
  • Eastern Michigan Chapter, Healthcare Financial Management Association, “What You Need To Know About The Amended Cost Report and Appeals Process"
    Event |
  • Amended Cost Report and PRRB Appeals Rules
    Event | Webinar | | | Presenter
  • Event | Mount Pleasant, MI | May 25-27, 2016 | | Presenter
  • MHA Council on Small or Rural Hospitals
    Event | Okemos, MI | | | Presenter
  • Event | Baltimore, MD | April 13-15, 2016 | | Presenter
  • Investor Ownership of the Health Enterprise: The Transformation from Mission to Money
    Event | Plymouth, MI | | | Presenter
  • Jurisdiction Practice Before The PRRB: What's New In 2016
    Event | Warren, MI | | | Presenter
  • Medicare Payment Principles
    Event | Warren, MI | | | Speaker
  • Event | Webinar | | | Presenter
  • Event | Webinar | | | Presenter
  • Medicare Litigation Update
    Event | Baltimore, MD | | | Presenter
  • It Was 20 Years Ago Today—A Health Law Retrospective from 1994-2014
    Event | Plymouth, MI | | | Presenter
  • Event | Washington, D.C. | January 23-24, 2014 | | Presenter
  • A “Consumer’s Guide” To Identifying, Preserving and Pursuing Cutting Edge Medicare Appeals
    Event | | | Co-presenter
  • Medicare Litigation Update
    Event | Baltimore, Maryland | March 20-22, 2013 | | Presenter
  • Year in Review
    Event | Baltimore, Maryland | March 20-22, 2013 | | Presenter
  • Appeals of Reimbursement Decisions
    Event | | | Moderator
  • Legal Issues Affecting Academic Medical Centers and Other Teaching Hospitals
    Event | | | Presenter
  • Medicare Litigation Update
    Event | | | Presenter
  • Provider Reimbursement Review Board (PRRB) Practices and Procedures
    Event | Warren, MI | | | Presenter
  • Physician Supervision of Diagnostic Testing
    Event | |
  • Event | Southfield, MI | |
  • Event | Warren, MI | |
  • Medicare Part A Jurisdiction Litigation Update
    Event | Baltimore, MD |
  • The RAP Practice Group's Year in Review
    Event | Baltimore, MD | March 30-April 1, 2011
  • Event | Baltimore, MD | |
  • Event | Webinar | | Moderator
  • Graduate Medical Education Payment Implications of the Healthcare Reform Law Part II: CMS Issues Final Regulations
    Event | Plymouth, MI | | | Presenter
  • Event | Plymouth, MI | September 30-October 1, 2010 | | Speaker
  • Recovery Audit Contractors
    Event | Mt. Pleasant, MI | |
  • Hospital/Physician Relationships
    Event | Birmingham, MI | |
  • The Provider Reimbursement Review Board
    Event | Baltimore, MD | March 24-25, 2010 |
  • Provider Reimbursement Review Board Jurisdiction
    Event | Baltimore, MD | March 24-25, 2010 |
  • The Year in Review
    Event | Baltimore, MD | |
  • Event | Lansing, MI | | Presenter
  • Medicare Provider Reimbursement Review Board Appeals
    Event | Plymouth, MI | |
  • Medicare Bad Debt Payment
    Event | Grand Rapids, MI | |
  • Recovery Audit Contractors
    Event | Lansing, MI | |
  • Recent Trends in Medicare Appeals
    Event | Novi, MI | | | Presenter
  • Event | | | Speaker
  • 2006: The RAP Practice Group's Year in Review
    Event | March 21-22, 2007
  • Hot Medicare Appeals
    Event | |
  • 2007 IPPS Final Rule: What You Need To Know
    Event | | Co-presenter
  • PRRB Jurisdiction
    Event | Baltimore, MD | |
  • Medicare and Medicaid
    Event | Baltimore, MD | |
  • Emerging Issues in Healthcare Law
    Event | Orlando, FL | |
  • Healthcare Financial Management Association
    Event | Sterling Heights, MI |
  • Healthcare Financial Management Association Fall Conference
    Event | Ypsilanti, MI |
  • Healthcare Financial Management Association Spring Conference
    Event | Mt. Pleasant, MI |
  • Reimbursement Update
    Event | Livonia, MI | |
  • Michigan Association of Medical Educators
    Event | East Lansing, MI |
  • Emerging Issues In Medicare and Medicaid Payment
    Event | Troy, MI | |
  • Developments in Medicare Graduate Medical Education Payment
    Event |
  • The Proposed Medicare Bad Debt Regulation Amendment
    Event |
  • Institute on Medicare and Medicaid Payment Issues
    Event | Baltimore, MD | |
  • Advanced Reimbursement Update
    Event | Troy, MI | |
  • The Revised PRRB Instructions and the Mediation Process
    Event |
  • Highlights of the Fiscal Year 2003 Inpatient Prospective Payment System Regulations
    Event |
  • Compliance 2002: Beyond the Basics
    Event | Ypsilanti, MI | |
  • The Amended Medicare Provider Based Rule
    Event |
  • PRRB Mediation Process and the Newly Revised PRRB Instructions
    Event | | | Co-presenter
  • Institute on Medicare and Medicaid Payment Issues
    Event | Baltimore, MD | April 1-2, 2002 |
  • Eastern Michigan Chapter of HFMA Insurance & Reimbursement Committee
    Event | Livonia, MI |
  • 8th Annual Michigan Health Law Institute
    Event | Troy, MI | |
  • Emerging Issues 2002
    Event | Phoenix, AZ | February 28-March 1, 2002 |
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