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Alissa D. Fleming

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Health care providers call upon Alissa Fleming for her unique perspective as a former nurse to help them navigate matters involving regulatory compliance and litigation.

Professional Biography


As both an attorney and a registered nurse, Ms. Fleming uses her first-hand experience to understand and strategically address her clients' most significant challenges.

Ms. Fleming is the leader of Baker Donelson's Health Care Regulatory team. She represents large hospital systems, skilled nursing facilities, clinical laboratories, home health agencies, hospice providers, behavioral health providers, assisted living facilities, physicians, and health care professionals. She focuses her practice on regulatory compliance; operations and risk management; Medicare and Medicaid reimbursement; Medicare and Medicaid audits and appeals; payor disputes and litigation; post-payment reviews; voluntary repayments; investigations and disclosures under the Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General (OIG) self-disclosure protocols involving potential violations of the False Claims Act (FCA), Anti-Kickback Statute, and Stark Law; internal investigations involving allegations of health care fraud and retaliation under the FCA; medical staff matters; disciplinary proceedings and peer review; confidentiality of medical information; facility licensing; provider based regulations; 340B; scope of practice; professional licensing, and other health care issues involving state and federal law.

When clients need assistance with litigation, Ms. Fleming offers counsel at the trial and appellate levels, including jury and non-jury trials and hearings, such as administrative proceedings and appeals, in claims ranging from disciplinary proceedings, payor-provider disputes, and qui tam whistleblower actions. With respect to payor disputes, she has represented hospitals, health systems, behavioral health providers, home health providers, and hospice providers in payment disputes against payors including commercial health insurers and managed care organizations, Medicare managed care organizations, Medicaid managed care organizations, Medicare, and Medicaid.

  • Represented a large health system in a dispute adverse to a national Medicare Advantage Organization (MAO) involving improperly downgraded claims and denials of inpatient admission, resulting in a favorable settlement for the health system.

  • Represented a large health system in a dispute adverse to a national MAO involving improperly downgraded claims and denials of inpatient admission.

  • Represented national for-profit hospital system in disputes adverse to national MAO involving improperly downgraded claims and denials of inpatient admission.

  • Represented multi-state hospital system in 340B underpayments.

  • Represented a large academic medical center in a payor dispute adverse to a national MCO for non-payment/underpayment for inpatient behavioral health services.

  • Represented a large academic medical center in a dispute adverse to a national MAO and MCO involving numerous improper reimbursement and contractual practices, including underpayments.

  • Represented a behavioral health provider in alleged overpayments arising from post-payment review adverse to a national Medicaid managed care company, resulting in a complete reversal of the overpayments and contract amendments.

  • Represented a regional home health provider in arbitration adverse to a national MAO involving improper denial of claims based on coding, timely filing, medical necessity, and additional issues, resulting in favorable settlement for the provider.

  • Represented a national hospice provider in a Medicaid overpayment appeal, resulting in a favorable settlement for the provider.

  • Represented a national hospice provider in a Zone Program Integrity Contractor (ZPIC) audit, resulting in a seven-figure overpayment and appeals to the Administrative Law Judge (ALJ) and Medicare Appeals Council (MAC).

  • Represented large, multi-state skilled nursing facilities before the Provider Reimbursement Review Board (PRRB) to challenge Medicare Quality Reporting Program (QRP) Annual Payment Update (APU) reductions.

  • Represented a large, multi-state rehabilitation hospital before the Administrative Law Judge to challenge Medicare hospital price transparency penalties.

  • Listed in Charleston Business Magazine's Legal Elite for Healthcare and Labor & Employment (2020 – present); Employment – Defendant (2023)
  • Listed as a South Carolina Rising Star in Health Care and General Litigation (2013 – 2015)
  • AV® Preeminent™ Peer Review Rated by Martindale-Hubbell
  • Member – American Health Lawyers Association (AHLA)
  • Member – Charleston County Bar
  • Council Member – South Carolina Bar, Health Care Law Section
  • Member – American Association of Nurse Attorneys
  • Member – TASIS Foundation Board of Directors
  • "Navigating Medical Staff Issues: Challenges Involving Medical Necessity," AHLA Advising Providers: Legal Strategies for AMCs, Physicians, and Hospitals Conference (February 2025)
  • "Navigating the 340B Maze: Payment Implications and Strategies for Providers Related to Medicare Advantage," South Carolina Hospital Association Webinar (January 2025)
  • "Case Studies and Medicare Advantage Disputes: Practical Implications and Strategies for Providers," South Carolina HFMA 2024 Annual Conference (May 2024)
  • "To Disclose or Not to Disclose? Navigating a Compliance Complaint from A-Z with General Counsel," HCCA Annual Compliance Institute (April 2024)
  • "Improving Revenue Cycle from the Legal Eye View," 2024 HFMA South Eastern Summit (February 2024)
  • "Hot Topics in Provider Repayments," AHLA's Speaking of Health Law Podcast (February 2024)
  • "2024 Medicare Advantage and Part D Final Rule: Helpful Points for Providers," South Carolina Healthcare Financial Management Association (October 2023)
  • "Navigating the TPE Process and Updates to the OIG Work Plan: What Hospice Providers Need to Know to Prepare and Respond," South Carolina Home Health and Hospice Association Conference (September 2023)
  • "Navigating Payor Disputes," South Carolina Healthcare Financial Management Association Annual Institute (May 2023)
  • "Emerging from the Emergency: Legal and Regulatory Challenges in the Post-PHE Era," Association For Home & Hospice Care's (AHHC) 51st Annual Convention & Exposition (April 2023)
  • Moderator – "Regulatory Pressure Points in a New World: A Post-Pandemic Preview," 2022 Baker Donelson Long Term Care Symposium (November 2022)
  • "The Post-Emergency Horizon: Navigating Through The Termination Of Covid-19 Public Health Emergency (PHE) And Other Emergency Declarations," South Carolina Primary Care Association (October 2022)
  • "Quality of Care/Resident Abuse & Neglect in Long Term Care," North Carolina Health Care Facilities Association (NCHCFA) (October 2022)
  • "Liability and Long-Term Care," AHLA Annual Meeting 2022 (June 2022)
  • "No Surprises Act and Good Faith Estimates," Association Of South Carolina Oncology Managers (ASCOM) (May 2022)
  • "Update on CARES Act Provider Relief Fund," ASCOM (May 2021)
  • "The Use of Telemedicine in Home Health and Hospice," South Carolina Home Care and Hospice Association (SCHCHA) webinar (December 2020)
  • "Enhanced Enforcement Actions Against Long-Term Care Facilities, State Survey, and Recent Interim Final Rule Making," Health Care Compliance Association (HCCA) webinar (September 2020)
  • "Telehealth Services, Fraud, and Abuse – Emerging Issues," Palmetto Care Connections (February 2020)
  • "Legal Issues Impacting Home Care & Hospice Professionals," SCHCHA 2019 Annual Conference and Expo (December 2019)
  • "Employers Beware: A Speed Round of Trending Topics," South Carolina Chapter of the Association of Corporate Counsel (ACC) CLE Seminar (June 2019)
  • "Legal Quick Hit: Compliance, Ethics & Government — A Healthcare Perspective: The Role of Outside Counsel in Internal Investigations and Considerations Toward Protecting the Attorney Client Privilege," ACC webinar (June 2018)
  • "Risk Management," South Carolina Department of Mental Health (SCDMH) panel (2013)
  • "HIPAA Uses and Disclosures," Trident Technical College: Medical Law & Ethics Course (2010)

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