Picture of Abby Pendleton Esq.

Abby Pendleton, Esq.

Founding Shareholder

ABBY PENDLETON is a founding shareholder of The Health Law Partners, P.C. She graduated Magna Cum Laude from Wayne State University Law School in 1996 and is a member of the Order of the Coif. Ms. Pendleton was a member of the Wayne State Law Review and served on its editorial board as a Senior Articles Editor. While at Wayne State, she was a recipient of the American Jurisprudence Book Awards in Contracts and Criminal Law as well as the Deloitte and Touche LLP Award for her achievement in tax law.

Ms. Pendleton has been practicing healthcare law since 1996. She regularly provides counsel to healthcare providers and organizations in a number of areas, including but not limited to: compliance, Recovery Audit Contractors ("RAC"), Medicare and other payor audits, fraud and abuse, reimbursement matters, and HIPAA Privacy and Security, and physician staff privilege and licensure matters. Ms. Pendleton also specializes in legal issues impacting billing and management companies, anesthesia and pain management providers, hospice providers and mental health agencies.

Ms. Pendleton is a member of the State Bar of Michigan (Member, Health Care Law Section) and State Bar of New York (Member, Health Law Section); the American Bar Association; the American Health Lawyer's Association; the Health Care Compliance Association; the Medical Group Management Association and the Michigan Medical Group Management Association.

Education
  • J.D., Wayne State University Law School, Detroit, Michigan, 1996
    • Honors
      • Magna Cum Laude
      • Order of the Coif
      • Law Review: Wayne Law Review Senior
      • Articles Editor Honors: Recipient of the American Jurisprudence Book Awards in Contracts and Criminal
      • Law Honors: Recipient of the Deloitte and Touche LLP Award for Tax Law
  • B.S.B.A, Central Michigan University, Mount Pleasant, Michigan, 1993
    • Honors
      • Cum Laude
    • Major: Finance
Jurisdictions Admitted to Practice
  • Michigan
  • New York
  • U.S. District Court Eastern District of Michigan
Professional Associations
  • State Bar of Michigan
    • Health Care Law Section
  • American Health Lawyers Association
  • Health Care Compliance Association
  • American Bar Association
  • Medical Group Management Association
  • State Bar of Michigan Health Care Law Section Providers Subcommittee of the Substantive Law Committee
    • Past Chair
  • State Bar of Michigan, Health Care Council
    • Past Member
  • New York State Bar Association
    • Health Law Section
Honors & Awards
  • Abby Pendleton, Esq. was selected by Michigan Lawyers Weekly, Women in the Law, 2011.
  • Abby Pendleton, Esq. was selected as a dbusiness Magazine Top Lawyer in Healthcare Law 2011.
  • Abby Pendleton, Esq. received the American Jurisprudence Book Awards in Contracts and Criminal Law, 1996.
  • Abby Pendleton, Esq. received the Deloitte & Touche LLP Award for Tax Law, 1996.
Published Works

"Medicare Beneficiaries Win Right to Challenge Certain Outpatient Observation Placement Orders" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., ABA Health eSource, May 18, 2020.

"AseraCare: Falsity and the False Claims Act" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., BC Advantage, January/February 2020.

"CMS Revises Guidance Regarding the Use of Statistical Sampling for Overpayment Estimation" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., BC Advantage November/December 2019.

"Inpatient Rehabilitation Facility (IRF) Appeals Settlement Initiative" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., ABA Health eSource, Vol. 15, No. 12, August 1, 2019.

"OMHA Medicare Appeals Backlog to be Eliminated by 2022" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., BC Advantage, March/April 2019.

"District Court Rules OMHA Appeals Backlog to be Eliminated by 2022" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., ABA The Health Lawyer, Vol. 29, No. 3, February 2019.

"Courts Recognize Irreparable Injury Caused by Medicare Appeals Backlog" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., BC Advantage, January/February 2019.

Jessica L. Gustafson, Esq. and Abby Pendleton, Esq. were quoted in "RACs Seek to Regain Reviewing Privileges for Medicare Claims", Modern Healthcare, September 19, 2018.

"CMS Removes Total Knee Arthroplasty from the Inpatient-Only List" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., BC Advantage, March/April 2018.

"HHS Seeks to Improve Medicare Appeals Process" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., ABA The Health Lawyer, Vol. 29, No. 5, June 2017.

"Medicare Appeals Adjudication Delay Update: Lawsuit Decided in Favor of Appellants (For Now)" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., ABA The Health Lawyer, Vol. 29, No. 3, February 2017.

"Be on NOTICE: CMS's Proposed Rule on the NOTICE Act Has Been Published," by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., ABA Health eSource, Vol. 12, No. 10, June 2016.

Clinton Mikel, Esq. and Abby Pendleton, Esq. were quoted in "3 Common HIPAA Breaches - And How to Avoid Them" by Kristin J. Webb, The Coding Institute, May 2016.

"Implications of the 2016 OPPS Final Rule: CMS Finalizes Revisions to its 2-Midnight Rule for Inpatient Hospital Admissions" by Jessica Gustafson, Esq., and Abby Pendleton, Esq., ABA Health eSource, Vol. 12 No. 4, December 2015.

"Wading through Muddy Waters: Hospitals Plan for Revisions to CMS' 2-Midnight Rule" by Jessica L. Gustafson, Esq., and Abby Pendleton, Esq., ABA Health eSource, July 2015.

"Healthcare Providers and Suppliers Eagerly Anticipate Planned Improvements to Recovery Audit Program" By Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., ABA Health eSource, February 2015.

Legal Manual for New York Physicians, 4th Edition, Vol. 2, Chapter 56, "Medicare Audits of Physician Claims and the Medicare Appeals Process" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., New York State Bar Association/Medical Society of the State of New York, 2014.

"Partial Relief in Sight: CMS Proposes Settlement of Pending Inpatient Hospital 'Status' Appeals" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., ABA Health eSource, Vol. 11 No. 2, October 2014.

"What Are Medicare Appeals?" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., American Bar Association, 2014.

"Hospitals Must Continue Implementation of Controversial 2-Midnight Rule" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., American Case Management Association, Collaborative Case Management, Vol. 11, Issue 05, Summer 2014.

"Medicare Appeals Adjudication Delays: Implications for Healthcare Providers and Suppliers" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., The Health Lawyer, Vol. 26, No. 5, June 2014.

"How Long Must We Wait? Repercussions for Health Care Providers and Suppliers of ALJ Adjudication Delays" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., AHLA Newsletter, May 2014.

"Hospitals Brace for 'Probe and Educate' MAC Audits as Physician Documentation in Hospitals Takes on Even Greater Importance: Impact of the 2014 Inpatient Prospective Payment System ('IPPS') Final Rule on Hospital-Based Physician Documentation" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., BC Advantage, February/March 2014.

"2-Midnight Rule Update: Hospitals Must Continue Implementation of the 2-Midnight Rule" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., The Health Lawyer, Vol. 26, No. 4, April 2014.

"The Latest Development in Federal Health Care Audit Programs: Supplemental Medical Review Contractor" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., BC Advantage, January 2014.

Jessica L. Gustafson, Esq. and Abby Pendleton, Esq. were quoted in "Whacked by RAC", Hospitals & Health Networks, January 14, 2014.

Archive

2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2000 | 1999 | 1998

Speaking Engagements

"High Stakes of Compliance in an Evolving Regulatory Environment" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., TLC 2020, American College of Physician Advisors.

"Legal Issues Affecting Hospital Case Managers" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., CMSA 2020 Annual Conference Virtual Edition, June 28 - July 2, 2020.

"Hot Legal Issues with MA Plans" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., The 7th National Physician Advisor and Utilization Review Boot Camp, Washington, D.C., July 31, 2019.

"Legal Issues Affecting Hospital Case Managers" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., CMSA 2019 Annual Conference, Las Vegas, NV, June 11, 2019.

"Explore Appeal Avenues and Evaluate the Costs for Addressing Denials at Each Level" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq.,16th Annual Physician Advisor and Medical Director Summit, Chicago, IL, April 15, 2019.

"Courts Recognize Irreparable Harm to Providers Caused by Medicare Appeals Backlog" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., Special Edition Finally Friday, September 18, 2018.

"Regulatory Update - 60 Day Recoupment, CMS/OMHA Appeal-Reduction, Front-End Compliance and Appeals" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., The 6th National Physician Advisor and Utilization Review Team Boot Camp 2018, Los Angeles, CA, July 27, 2018.

"Mission Creep:  The Physician Advisor and Payer Contracts" by Elizabeth Lamkin, MHA (President, PACE Healthcare) and Abby Pendleton, Esq., 2018 National Physician Advisor Conference/SEPAS 2018, Greenville SC, May 1, 2018.

"Denials Scene" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., 2018 National Physician Advisor Conference/SEPAS 2018, Greenville SC, May 1, 2018.

"Cost Breakdown of Denials Management" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., World Congress 15th Annual Physician Advisor and Medical Director Summit, Orlando, FL, March 20, 2018.

"Mock ALJ Hearing" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., World Congress 15th Annual Physician Advisor and Medical Director Summit, Orlando, FL, March 19, 2018.

"Manage Medicare Denials Amidst Perceived Inconsistency and Lack of Transparency" by Jessica L. Gustafson, Esq., Abby Pendleton, Esq., and Mohammad Shaheed, M.D. (Rochester Regional Health System),  World Congress 5th Annual West Physician Advisor & Case Management Summit, Phoenix, AZ, October 18, 2017.

"Meet the Dream Team: 5) Legal Team - When All Else Fails" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., 5th National Physician Advisor and Utilization Review Boot Camp, FL, July 21, 2017.

"Develop Effective Strategies for Addressing Appeals and Denials" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., 14th Annual Physician Advisor Summit, Orlando, FL, March 20, 2017.

“Beyond Filing Appeals – Proven Success Strategies Using PAs” by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., The National RAC Summit 3rd Physician Advisor and UR Team Boot Camp, San Antonio, TX, July 23, 2015.

“Successfully Appealing Medicare Claim Denials (Case studies)” by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., The Association for Medical Imaging Management (“AHRA”) 2015 Annual Meeting, Las Vegas, NV, July 22, 2015.

“Overcome Claim Denials with an Administrative Law Judge through Effective Positioning and Oral Arguments” by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., World Congress 12th Annual National Association of Physician Advisors (“NAPA”) Physician Advisor Summit, Orlando, FL, March 17, 2015.

Jessica L. Gustafson, Esq. and Abby Pendleton, Esq. gave a Legal and Regulatory Update at the 9th National RAC and MAC Summit, Washington D.C., November 13-14, 2014.

"Strategies to Successfully Manage Denials and the Appeals Process" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., World Congress 2nd Annual West Physician Advisor & Case Management Summit, San Diego, CA, October 20-21, 2014.

Abby Pendleton, Esq. presented on the topic of Compliance at the Michigan Association of Reimbursement Officers (MARO) Fall Conference.

Jessica L. Gustafson, Esq. and Abby Pendleton, Esq. presented at The National RAC Summit 2nd Physician Advisor and UR Team Boot Camp Best Practices from Pre-Admission to Appeal, Chicago, IL, July 14-16, 2014.

"Successfully Deal with Denials"  by Jessica L. Gustafson, Esq., Abby Pendleton, Esq., and Michael Salvatore, MD, Pre-Summit Workshops, Hotel Caribe Royale, Orlando, FL, March 24, 2014.

"Overview and Recap of the 2014 CMS IPPS Final Rule" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., Pre-Summit Workshops, Hotel Caribe Royale, Orlando, FL, March 24, 2014.

"Compliance in 2014: What you Need to Know!" presented by Abby Pendleton, Esq. and Ranjan Sachdev, MD, MBA, CHC, and moderated by Jack Bert, MD, American Academy of Orthopaedic Surgeons Annual Meeting, New Orleans, LA, March 14, 2014.

"Advanced Practice Providers-The Role of Nurse Practitioners" by Nancy George and Abby Pendleton, Esq., ICLE's 20th Annual Health Law Institute, The Inn at St. John's, Plymouth, MI, March 6-7, 2014.

"Healthcare Laws and Legal Issues" by Abby Pendleton, Esq., AHIA Michigan Regional Seminar, February 18, 2014.

Archive

2013 | 2012 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2003 | 2002 | 2001 | 1999

Past Employment Positions
  • Wachler & Associates, P.C., Associate, Partner, 1996-2009
  • Wachler & Associates, P.C., Law Clerk, 1994-1996