Mark Polston helps hospital systems and other healthcare providers navigate the Medicare regulatory world. As the former Chief Litigation counsel for the Centers for Medicare & Medicaid Services, Mark has decades of experience in Medicare reimbursement policy and Medicare fraud defense. As a partner in the King & Spalding Healthcare practice, Mark advises healthcare providers on Medicare reimbursement strategy, advises clients on complying with regulatory requirements, represents hospitals in Medicare reimbursement litigation and defends providers against government enforcement actions.
For more than 20 years, Mark has counseled clients in the complex world of the Medicare program, a regulatory environment so intricate that the Supreme Court has described it as "unintelligible to the uninitiated." In that vein, Mark specializes in complicated Medicare reimbursement litigation, including the successful challenge to Medicare's so-called "Two Midnight" 0.2 percent rate cut. As a former high-ranking attorney within the Department of Health and Human Services, Mark brings credibility and an insider's knowledge when advocating before CMS and Congress on Medicare and Medicaid issues.
Drawing upon his experience as CMS's former chief litigation counsel, Mark represents hundreds of hospitals in Medicare reimbursement appeals. His cases typically challenge national Medicare reimbursement policies with hundreds of millions of dollars at stake. On the defense side, Mark's years of government fraud enforcement experience and Medicare knowledge translates to surgically effective representation of providers in Medicare fraud investigations.
More than just a litigator, Mark's years-long experience with Medicare and Medicaid means that he possesses a deep and wide body of knowledge about these programs which allows him to counsel and strategize with clients on diverse topics such as Graduate Medical Education reimbursement for teaching hospitals, Medicare's "provider-based" rules, and Medicare coverage standards for inpatient services.
With all of this experience, Mark has become a nationally-recognized expert on Medicare reimbursement and speaks annually at the Medicare and Medicaid Payment Institute sponsored by the American Healthcare Lawyers' Association. Mark is also a co-editor of the Reimbursement Advisor, a monthly newsletter focusing on Medicare and Medicaid reimbursement issues.