“Carla has been representing my companies for 25 years.”Don Miller, President, Four Square Healthcare
Carla J. Cox is an experienced health care regulatory lawyer who primarily represents long term care providers including nursing homes, assisted living facilities, retirement communities, home health agencies, rehabilitation facilities and ICF/MR facilities in state and federal health care regulatory and enforcement matters.
Areas of expertise include:
- State Medicaid and Federal Medicare regulation and reimbursement
- Appeals of Medicare/Medicaid enforcement actions including:
- Imposition of civil monetary penalties
- Denial or suspension of Medicare and Medicaid payment
- Termination of Medicare/Medicaid participation
- Denial and revocation of state provider licenses
- Challenges to audit findings by state and federal auditing entities and potential recoupment actions
- Medicare/Medicaid compliance issues such as self-reporting of Medicare/Medicaid overpayments
- State and federal OIG investigations of civil Medicare/Medicaid fraud
- Appeals of professional license revocation, suspension, denial or nonrenewal
Carla has represented clients before the following state and federal administrative agencies:
- Texas Department of Aging and Disability Services
- Texas Department of State Health Services
- Texas Health and Human Services Commission
- Texas Medical Board
- Texas Board of Nursing
- Texas Board of Pharmacy
- Texas Nursing Facility Administrators Advisory Committee
- Texas Department of Family and Protective Services
- Texas State Office of Administrative Hearings (SOAH)
- US Department of Health and Human Services Departmental Appeals Board
On the federal level, Carla has represented clients before the Department of Health and Human Services Departmental Appeals Board (Medicare/Medicaid termination and exclusion), the Provider Reimbursement Review Board, and in connection with investigations of Medicare/Medicaid fraud by the Office of Inspector General.
Carla has extensive experience representing clients before state administrative agencies including the following:
- Texas Department of State Health Services—Appeals of adverse licensure actions and assistance with licensing issues involving hospitals and food manufacturers and distributors.
- Texas Health and Human Services Commission—Assistance with Medicaid reimbursement issues involving health care providers. Negotiating contractual disputes for entities that contract with HHSC.
- Texas Medical Board—Represents physicians in connection with Board investigations and adverse licensure actions.
- Texas Board of Nursing—Represents nurses in connection with Board investigations and adverse licensure actions.
- Texas Board of Pharmacy—Represents pharmacists in connection with Board investigations and adverse licensure actions.
- Texas Nursing Facility Administrators Advisory Committee—Represents nursing home administrators in connection with investigations and adverse licensure actions.
- Texas Department of Family and Protective Services—Assistance with investigations and adverse licensure actions against child care facilities, child placement (foster care) agencies, and long term residential treatment facilities.
- State Bar of Texas, Health Law and Administrative Law Sections
- American Health Lawyers Association
- Austin Health Lawyers Association
- Texas Healthcare Association
- Texas Association for Home Care & Hospice
- Travis County Bar Association
- Leaders Circle Texas Center for Women in Law
- Chancellor’s Council of the University of Texas System
News & Events
All Texas Medicaid Providers Must Re-Enroll by June 17th…or Else!
Helping clients’ businesses stay healthy
TDADS denying HCSSA License Renewals because of Tax Liens
Reasonable Suspicion of a Crime in a Long-Term Care Facility and OIG Findings
Recent Federal Court Ruling: No ERISA Preemption of Texas Prompt Pay Law Regarding Payment Deadlines; Texas Legislature May Act on Prompt Pay Issues
Recent Federal Court Ruling on Application of Texas Prompt Pay Laws to Self-Funded, Medicaid and Out-of-State Plans and Their Third Party Administrators
Jackson Walker Named Outstanding Firm for Women by Travis County Women Lawyers Association