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Drawing on more than a decade of litigation experience with the U.S. Department of Health and Human Services (HHS) Office of the General Counsel for the Centers for Medicare & Medicaid Services (CMS) Division, Andrew Tsui assists health care clients seeking to develop comprehensive and durable approaches to the Medicare regulatory environments. Andrew’s extensive background as lead agency counsel and his track record of success before both administrative and federal courts nationwide provides a unique optic to support the critical legal and business challenges his clients confront.

A trusted advocate for healthcare providers and payers alike, Andrew also assists clients in the medical device, biopharmaceutical, and other emerging healthcare technology industries bring their products to market with confidence. His work with multi-national life sciences companies emphasizes the importance of developing a coverage, coding, and reimbursement approach that harmonizes with necessary FDA-approval processes. Recently, Andrew handled the direct advocacy efforts before CMS DME-MAC contractors that resulted in a $350m business impact for his client. 

Concentrations

  • Medicare/APA litigation
  • Cost-Sharing Reduction (CSR) Payments, Risk Adjustment under the Affordable Care Act
  • Emergency physician payments
  • Accountable Care Organizations (ACOs), Bundled Payments for Care Improvement (BPCI/BPCI-Advanced) Initiatives, and other CMS CMMI Alternative Payment Models
  • Medicaid State Plan Amendments (SPAs) and Prior Authorizations
  • Inpatient and Outpatient Prospective Payment Systems (IPPS/OPPS) and Disproportionate Share Hospital (DSH) payment adjustments
  • Medicare bad debt reimbursement
  • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) coding disputes
  • Home health and hospice payments and appeals
  • Medicare Part B Cost Plans
  • Breakthrough Devices
  • New Technology Add-on Payments (NTAP)
  • ESRD PPS Transitional Add-on Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES)
  • COVID-19 Provider Relief Fund (PRF)

Capabilities

Experience

  • Litigation Attorney, U.S. Department of Health and Human Services, Office of the General Counsel, CMS Division, 2008-2019
  • Special Assistant U.S. Attorney, U.S. District Court for the District of Columbia
  • Policy Analyst, CMS Center for Medicare & Medicaid Innovation (CMMI), 2012-2013

Credentials

Education
  • J.D., University of North Carolina School of Law
  • M.P.H., University of North Carolina, Gillings School of Global Public Health
  • B.A., with high honors, Wesleyan University
Admissions
  • New York
Not admitted in the District of Columbia. Practice limited to Federal courts and Agencies.