Picture of Jessica L. Gustafson Esq.

Jessica L. Gustafson, Esq.

Founding Shareholder

JESSICA L. GUSTAFSON is a founding shareholder with The Health Law Partners, P.C. Ms. Gustafson represents hospitals, health systems, hospices, home health agencies, physicians and other health care providers and suppliers in an array of health care legal matters. Ms. Gustafson devotes a substantial portion of her practice to representing providers in the Recovery Audit (“RAC”) and Medicare audit appeals process. She also regularly assists clients with compliance and reimbursement matters, overpayment refunds, Medicare enrollment matters, as well as other health care regulatory matters.

Ms. Gustafson is a member of the American Bar Association (ABA) Health Law Section, American Health Law Association, and Michigan Bar Association Health Care Law Section. She is actively involved in the ABA Health Law Section, serving as a Council Member and as a Vice-Chair of the Editorial Board of the publication ABA Health eSource. She also serves as the Chair of the Advisory Board to the American College of Physician Advisors (ACPA).

While in law school, Ms. Gustafson served as a member of the Wayne Law Review Editorial Board as a Senior Articles Editor. She also served as a judicial intern to the Honorable Robert H. Cleland, United States District Court, Eastern District of Michigan.

Education
  • J.D., Wayne State University Law School, Detroit, Michigan, 2005
    • Law Review: The Wayne Law Review, 2003 - 2005
  • B.A., Miami University, Oxford, Ohio, 2002
    • Honors: Cum Laude
    • Major: Speech Communication
Jurisdictions Admitted to Practice
  • Michigan
  • U.S. District Court Eastern District of Michigan
  • New York
Professional Associations
  • American Health Law Association
  • American Bar Association, Health Law Section
    • Council Member
    • Vice-Chair, ABA Health eSource
    • Past Chair, Membership Committee
    • Past Chair, Physician Issues Interest Group
  • Michigan Bar Association, Health Care Law Section
  • American College of Physician Advisors
    • Chair, Advisory Board
Honors & Awards
Published Works

Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., "What Are Medicare Appeals" (2nd Edition), Chicago: American Bar Association, 2021

Jessica L. Gustafson, Esq. was quoted in "OPPS Final Rule:  CMS Ends Inpatient-Only List, Puts Related Audits on Ice Indefinitely," by Nina Youngstrom, Report on Medicare Compliance, Vol. 29, No. 43, December 7, 2020.

"Hospitals Brace for Renewed Focus on Total Joint Procedures" by Jessica L. Gustafson, Esq., American College of Physician Advisors Newsletter, September 25, 2020.

"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.

Jessica L. Gustafson, Esq. was quoted in "Court Says Inpatients Changed to Observation Have Right to Appeal, Orders New Process" by Nina Youngstrom, Report on Medicare Compliance, Vol. 29, No. 12, March 30, 2020.

Jessica L. Gustafson, Esq. was quoted in "In Unusual Move, MACs Recoup Whole DRG Payment for PACT Errors; Rebuttals May Help" by Nina Youngstrom, Report on Medicare Compliance, Vol. 29, No. 4, February 3, 2020.

Jessica L. Gustafson, Esq. was quoted in "Rappin' About RACs" by Susan Chapman, For The Record, Vol. 32, No. 1, P. 22, January/February 2020.

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

Jessica L. Gustafson, Esq. was quoted in "Outlook 2020: Integrity Rule, Inpatient Audits Will Stir Things Up; Privacy is 'Huge Focus'" by Nina Youngstrom, Report on Medicare Compliance, Vol. 29, No. 1, January 13, 2020.

"New Developments in Medicare Enforcement Actions: Impact of Allina" by Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq., AHRA Link, December 23, 2019.

"CMS Greatly Expands Its Authority to Deny and Revoke Providers' and Suppliers' Medicare Enrollment" by Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq., ABA The Health Lawyer, Vol. 32, No. 2, pg. 6, December 19, 2019.

"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.

"The Supreme Court Limits Agency Deference: Implications of Kisor v. Wilkie" by Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq., ABA The Health Lawyer, Vol. 32, No. 1, October 9, 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.

"CMS Revises Guidance Regarding the Use of Statistical Sampling for Overpayment Estimation" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., ABA Health eSource, Vol. 15, No. 11, July 1, 2019.

Jessica L. Gustafson, Esq. was quoted in "In Settlement Process, CMS Offers IRFs 100% Payment on Some Claims" by Nina Youngstrom, Report on Medicare Compliance, Vol. 28, No. 23, June 24, 2019.

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

"Court Deference to Agency Interpretations of Ambiguous Regulations: How Much is Too Much?" by Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq., AHRA Link, March 25, 2019.

Jessica L. Gustafson, Esq. was quoted in "Is The Medicare Appeals Backlog Finally Breaking?" by Rich Daly, HFMA.org, February 22, 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. 31, 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.

"The Department of Justice Softens its Stance on the Applicability of Federal Agency Guidance Documents" by Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq., BC Advantage, May/June 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.

"The Medicare Appeals Adjudication Backlog: New Initiatives May Offer Relief to Appellants" by Jessica L. Gustafson, Esq., BC Advantage, January/February 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 Delays: Is Relief Finally in Sight?" by Adrienne Dresevic, Esq., and Jessica Gustafson, Esq., AHRA Link, March 20, 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.

"Medicare Appeals Update: Is a Resolution Near?" by Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq., AHRA Link, August 22, 2016.

"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.

"Reporting and Returning Medicare Overpayment: Long Awaited Final Rule Provides Clarification" by Jessica L. Gustafson, Esq. and Clinton Mikel, Esq., ABA Health eSource, Vol. 12, No. 7, March 2016.

"New Final Rule on Medicare Overpayments" by Adrienne Dresevic, Esq., Jessica L. Gustafson, Esq., and Leslie Rojas, Esq., AHRA Link, March 18, 2016.

"Medicare Enrollment: CMS's Most Potent Program Integrity Tool Becomes Even Stronger" by Adrienne Dresevic, Esq., Donald Romano, Esq., and Jessica L. Gustafson Esq., The Health Lawyer, Vol. 28, No. 3, February 2016.

Jessica L. Gustafson, Esq. was quoted in "Ruling Gives Hospitals Hope on RAC Appeals Backlog" by Lisa Schencker, Modern Healthcare, February 9, 2016.

"Delays in Medicare Appeals Adjudication Part 2: A Potential Legislative Solution" by Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq., AHRA Link, February 8, 2016.

"Delays in Medicare Appeals Adjudication Part 1: Scope of the Problem" by Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq., AHRA Link, January 29, 2016.

"Implications of the 2016 OPPS Final Rule: CMS Finalizes Revisions to its 2-Midnight Rule for Inpatient Hospital Admissions" by Jessica L. 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.

"CMS Increases Enrollment Enforcement" by Adrienne Dresevic, Esq. and Jessica L. Gustafson, Esq, AHRA Link, March 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.

Archive

2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006

Speaking Engagements

"Reimbursement Dispute Hot Topics," by Jessica L. Gustafson, Esq. and Stefanie Philips, Esq. (Blue Cross Blue Shield of Michigan), ICLE 27th Annual Health Law Institute, March 11, 2021.

"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.

"Agency Deference and the Impact of Kisor in Healthcare: Challenging CMS and Other Agency Actions" by Jessica L Gustafson, Esq., Mimi Hu Brouillette, Esq., and Daniel Jarcho, Esq., Strafford Nationwide Webinar, September 25, 2019.

"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.

"Physician Compensation Trends to Consider in Establishing Fair Market Value (FMV)" moderated by Jessica L. Gustafson, Esq. and presented by Rud Blumentritt, CPA/ABV, CVA (Horne, LLP) and Albert "Chip" Hutzler, JD, MBA, CVA (HealthcareAppraisers), American Bar Association Health Law Section webinar, January 10, 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.

"Will Medicare Revoke Your Billing Privileges?" by Jessica L. Gustafson, Esq. and Donald Romano, Esq. (Foley & Lardner, Washington, DC), Appeal Academy webinar, June 26, 2018.

"Will Medicare Revoke Your Billing Privileges? Don't Answer "No" Too Quickly" by Jessica L. Gustafson, Esq. and Donald Romano, Esq. (Foley & Lardner, Washington, DC), American Bar Association Health Law Section & Chicago Medical Society Physicians Legal Issues Conference, Chicago, IL, June 8, 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.

"Are the Changes for the Better? What Appellants and Legal Counsel Need to Know about the New Medicare Appeals Rule" by Jessica L. Gustafson and Jacob J. Harper (Morgan Lewis), American Bar Association Health Law Section webinar, August 10, 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.

"Avoiding Compliance Pitfalls with the Use of Electronic Medical Records" by Jessica L. Gustafson, Esq. and Julie Hardy, MSA, RHIA, CCS, CCS-P (The Rybar Group), Michigan Health Care Law Section webinar, June 28, 2017.

"Drive Effective Collaboration between Payers and Providers" moderated by Jessica L. Gustafson, Esq., 14th Annual Physician Advisor Summit, Orlando, FL, March 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.

"The Current Audit Structure and Proposed Changes to the Medicare Appeals Process" by Jessica L. Gustafson, Esq., 4th Annual West Physician Advisor & Case Management Summit, San Diego, CA, October 24, 2016.

Jessica L. Gustafson, Esq. and Abby Pendleton, Esq. participated in a Mock ALJ hearing during the RAC Summit, 4th Physician Advisor and UR Team Boot Camp, San Antonio, TX, July 22, 2016.

"Appealing to the ALJ: Strategies for Success" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., 5th Annual Southeast Physician Advisor Symposium, Greenville, SC, April 27, 2016.

"Examine the Modified Two-Midnight Rule and Its Impact on the Documentation Process" by Jessica L. Gustafson, Esq., World Congress 13th Annual Observation Management Summit, Chicago, IL, April 26, 2016.

"Effective Strategies for Dealing with Denials and Appeals" by Jessica L. Gustafson, Esq., National Association of Physician Advisors 13th Annual Physician Advisor Summit, Orlando, FL, March 15, 2016.

"Medicare Provider Enrollment: Strategies for Denials, Revocations and Appeals" by Jessica L. Gustafson, Esq., Donald Romano, Esq., and Andrew B. Wachler, Esq., Strafford Nationwide Webinar, January 7, 2016.

"Understanding Changing CMS Rules and Regulations to Maintain Learning and Improve Quality" by Jessica L. Gustafson, Esq., World Congress 3rd Annual National Association of Physician Advisors ("NAPA") Physician Advisor and Case Management Summit, San Diego, CA, October 19, 2015.

"Medicare Audits and Appeals Environment: What Hospitals Need to Know" by Jessica L. Gustafson, Esq. and Abby Pendleton, Esq., Healthcare Financial Management Association ("HGMA") Gulf Coast 2015 Fall Institute, Houston, TX, October 16, 2015.

"How to Handle Difficult Situations - Point-Counterpoint", a panel discussion including Jessica L. Gustafson, Esq., The National RAC Summit 3rd Physician Advisor and UR Team Boot Camp, San Antonio, TX, July 23, 2015.

"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.

Archive

2014 | 2013 | 2012 | 2011 | 2010 | 2009