Recovery Specialists Firm Works to Bring About Change in Health Care Policy

By Debra Talcott
Legal News

Andrew Wachler, seated center, is flanked by Jennifer Colagiovanni (left) and Jessica Forster of his Royal Oak firm. Pictured, back row, l-r, are Dawn Harimoto, Dustin Wachler, Jeffery Campbell, and Amy Fehn.

Now that 72 million baby boomers are reaching retirement age and Medicare payments are accounting for a larger-than-ever-before portion of health care spending, the federal government has set out to identify and recover any overpayments made to health care providers by hiring private companies called Recovery Audit Contractors (RACs). That is when attorneys from Wachler & Associates, P.C. are asked to step in to help health systems, providers, and suppliers navigate the RAC appeals process.

"We have developed strategies for reducing overpayment demands and have successfully represented numerous hospitals and health systems, as well as providers and suppliers, with their appeals of claim denials and overpayment determinations," explains Andrew Wachler, founder of the Royal Oak firm that has served for more than 20 years as a national player in health care law.

It was in 2005, when the Medicare appeals process had changed for the first time in more than a quarter of a century, that attorneys from Wachler & Associates were asked to author an article outlining those changes for The Health Lawyer, a publication distributed to more than 11,000 business and health attorneys nationwide. In 2008, when health care providers prepared for the end of the RAC demonstration program and the beginning of the permanent RAC program, Wachler attorneys were again asked to submit their legal analysis for the publication.

"A unique feature of our firm is that we do a lot of writing and speaking," says Wachler. "We have an outstanding track record of training bright, young attorneys to become excellent health care lawyers."

In August, The Health Lawyer will publish an analysis of the Medicaid Integrity Program, the new Medicaid initiative to audit providers. That article is authored by Wachler and Amy Fehn, one of the firm's attorneys who also is a licensed and experienced RN.

Wachler & Associates will celebrate 25 years in business on January 1, 2010.

"I started out on my own in downtown Detroit in the Buhl Building with only a word processor and a secretary," says Wachler, who later moved the firm to Royal Oak.

Wachler selected Royal Oak because it is centrally located and convenient for clients.

"It is also a mile from my home in Huntington Woods and is the community my family is part of," says Wachler, making reference to his family's business, David Wachler & Sons Jewelers, which has been a fixture in nearby Birmingham for four generations.

As a young man attending Birmingham Groves High School, Wachler worked in his family's jewelry store but soon realized that the retail business wasn't his calling.

"I would often win family arguments with logic, and my mother said I 'would make a good lawyer,'" recalls Wachler.

With a goal of public service providing his ultimate career inspiration, Wachler attended the University of Michigan, where he graduated cum laude. In his first year there, he was honored to receive the prestigious William J. Branstrom Award, which recognizes the top 5 percent of the university's freshman class.

In 1978, Wachler earned his J.D. from Wayne State University Law School, again graduating cum laude. While there he founded the Wayne State Environmental Law Society, which does volunteer work on environmental issues. Wachler also clerked for the late Judge Justin Ravitz and was actively involved in Kenneth Cockrel Sr.'s campaign for Detroit City Council.

As a successful attorney, Wachler has expanded his idea of public service to include four key areas.

"My inspiration now is to continue to provide exceptional service, to create the best possible opportunities for my partners and associates, to participate in the evolution of health care reform, and to effect change in local and national health care policy," he says.

The firm's attorneys currently are doing some of the most interesting and sophisticated work of their careers, representing three of the largest and most prestigious health systems in the country. They are working with the American Hospital Association and the Greater New York Hospital Association to bring about change in Medicare policy relating to the RAC program.

"This single policy issue can have the greatest economic impact of any issue hospitals are facing in the RAC program," says Wachler. "It's exciting to be lead counsel on a project that can have a positive and substantial economic impact on every health system in the U.S."

Going back to the 1980s, Wachler & Associates initiated the first challenge of Blue Cross Blue Shield of Michigan's Provider Class Plan under Public Act 350 of 1980.

"After nine months of hearings, we were able to obtain a ruling that helped effectuate numerous policy changes and increase physician reimbursement to be more in line with surrounding states," says Wachler.

More recently, in the 1990s, the firm utilized Public Act 350 to challenge BCBSM's policy that prohibited reimbursement to physician-owned ambulatory surgery centers. As a result, physicians may now have an ownership interest in the ambulatory surgery centers where they practice.

"This policy change has lead to an increase of physician-owned surgery centers with the attendant benefit to patients of increased access, reduced costs, and high quality," Wachler explains.

Health and health care are issues of importance to Wachler and his family, even when they are unrelated to cases the firm has taken.

"The Juvenile Diabetes Research Foundation is an organization that is very important to me and my family," says Wachler. "We also support Wayne State University Law School which continues to educate exceptional lawyers," he adds.

Wachler and his wife Lori have two sons, Dustin and Jordan. The newest member of their family is a Chesapeake Bay retriever puppy.

"Both of our sons have worked in the office this summer. Dustin will attend Kent Law School in Chicago in the fall, and Jordan, a sophomore at Michigan State University, has also shown an interest in the law."

When not working on a case, planning his next lecture, or writing an article for publication, Wachler enjoys playing tennis and watching the Detroit Red Wings in action. Avid fans, he and Lori, who will celebrate their 25th wedding anniversary next year, were married at the Olympia Room in Joe Louis Arena.

Amidst their busy lives, however, it is time spent with family and friends that the Wachlers say is most important. The couple enjoys every opportunity to relax with relatives and friends at their second home in Charlevoix.

But it is the complicated regulations and legal concerns facing healthcare providers today that provide the most interesting challenge to this dedicated attorney and his talented staff, which includes a panel of physicians, coders, and consultants to assist the attorneys in doing their jobs.

"Our goal is to employ the best attorneys to service our clients in the most effective and efficient way and to foster a team approach to all we do," says Wachler.

Published:7/29/09