Felicia Y Sze is a recognized expert in Medicaid and Medicare reimbursement matters, focusing on both the managed care and fee-for-service programs. She advises healthcare providers, including hospitals, clinics, post-acute providers, pharmacies, durable medical equipment suppliers, and others, on a wide array of compliance and reimbursement matters and in disputes with managed care entities and government payors. She regularly reviews, revises and negotiates managed care contracts with a focus on those using alternative payment models.
Areas of Expertise
- Audits and compliance: Sze advises healthcare providers from both private and governmental audits. She has challenged numerous adverse findings through administrative and plan appeals, as well as escalating those to litigation or arbitration. She also counsels providers as to legal risks and options that arise with the discovery of billing irregularities or other past compliance issues.
- Contracting with payors: Sze consults with health care providers to assess payor contracts and relationships. In the increasingly complex environment of risk sharing and joint ventures, Ms. Sze provides guidance to providers as to how the structure of contractual relationships may affect their operations and finances. Her work in representing providers in disputes with payors uniquely positions her to identify obscure issues in payor contracts.
- Pursuing underpayments: Sze has represented a wide array of providers in pursuing underpayments and other contractual breaches from health care payors, especially managed care plans. She uses her thorough knowledge of the regulatory requirements imposed on plans in her advocacy on behalf of providers. She advances these disputes with an eye to improving the ongoing relationship that many providers have with plans.
- Electronic health records/meaningful use: Sze has worked with health care providers to develop, implement and use their electronic health records programs to comply with federal requirements. She has also assisted clients in preparing responses to meaningful use audits by both the Centers for Medicare and Medicaid Services contractor and the Office of the Inspector General. She has also advised clients as to requirements for certification of electronic health record systems by the Office of the National Coordinator for Health Information Technology.
- Coverage of new technology: Sze has advised manufacturers and providers to assist them persuade various healthcare payors, such as Medicare, Medicaid or commercial managed care, to cover new drugs, devices or equipment.
- Medicaid financing: Sze has advised providers as to the state financing of various Medicaid programs through provider taxes, intergovernmental transfers or certified public expenditure methodologies. Her understanding of the structure of Medicaid programs helps her guide providers as they embark on an ever-changing landscape, shaped by quickly changing laws and evolving Medicaid waivers.
- Public policy issues: Ms. Sze has also represented healthcare providers and their trade associations on public policy issues, including challenges to the validity of regulatory requirements, reimbursement changes. She has also drafted legislation affecting healthcare reimbursement and other policy issues. She works with providers and trade associations to draft comments to proposed federal and state regulations.
Ms. Sze earned her B.A. in Molecular and Cell Biology/Genetics from the University of California at Berkeley in 1996. She was the 1996 winner of the Kenneth Priestley award for outstanding student leadership and contribution to student welfare.
Ms. Sze earned her M.P.H. degree specializing in Community Health Sciences/Health Policy from the University of California at Los Angeles in 1998. After graduating from the University of California at Los Angeles, Ms. Sze served as a Presidential Management Intern for the U.S. Department of Health and Human Services. In this capacity, she acted as the Regional Affairs Specialist to the Regional Director, Region IX.
Ms. Sze received her J.D. from the University of California at Berkeley, Boalt Hall School of Law in 2004. In 2002, Ms. Sze was awarded the Barbee Legal Research Fellowship for healthcare law. In addition, Ms. Sze served as Research Assistant to Professor Marjorie Shultz for three years, during which time she researched and edited publications related to medical mistakes and racial disparities in health.
Professional Affiliations and Recognitions
- American Bar Association, Health Law Section
- American Health Lawyers Association
- Asian American Bar Association
- Bar Association of San Francisco
- California Society for Healthcare Attorneys, Board of Directors
- Healthcare Financial Management Association, Northern California, Chair of the Regulatory/Compliance/Reimbursement Committee