Peggy E. Kozal

Partner

  • Office Contact Info
  • Biography

    Peggy Kozal is a partner in the Denver office of Gordon & Rees and a member of the Health Care, Cyber, Privacy & Data Security and Employment Law practice groups. Ms. Kozal focuses her practice on healthcare regulatory and compliance matters, healthcare litigation, privacy and data security, Medicare/Medicaid certification and reimbursement, fraud and abuse, provider contracting, licensure and accreditation. She frequently represents a variety of healthcare professionals and entities, including long-term care facilities, assisted living facilities, home health agencies, hospices, federally qualified health centers, community health centers, behavioral health facilities, physician practices, medical spas, hospitals and other healthcare providers.

    Ms. Kozal provides legal guidance to identify critical problems and to apply compliance principles that minimize risk and promote client objectives. She also provides advice to healthcare clients in contemplated business transactions in order to structure legal, practical arrangements.

    As part of her work in the healthcare regulatory space, Ms. Kozal assists clients in the development and implementation of policies and procedures that are designed to reduce healthcare organizations’ vulnerability to fraud and abuse. She regularly helps clients by providing assistance in the investigation of internal complaints by potential whistleblowers and in responding to governmental investigations. Ms. Kozal also has significant experience in reimbursement disputes arising between providers and federally funded payers, as well as managed care entities.

    Ms. Kozal also assists healthcare clients with legal challenges arising in their day-to-day business operations. Recognizing the increased focus on efficiency, value and quality of care in the healthcare industry, Ms. Kozal advises clients in operational areas such as risk management and patient care, emergency/crisis management, incident response programs, medical staff and governance, privacy and data security, and state and federal patient confidentiality laws, including HIPAA, HITECH and 42 CFR Part 2.

    Ms. Kozal has defended individual and class state, local and federal employment matters, including class actions brought pursuant to the Fair Labor Standards Act (FLSA). Her experience in this type of matter includes defending a high-profile class action involving more than 100,000 class members alleging that they were denied state minimum wage and overtime pay.

    Ms. Kozal is experienced in handling a variety of litigation matters in administrative, state and federal courts, as well as arbitration forums. Ms. Kozal has worked with employers to enforce arbitration agreements and to draft enforceable arbitration agreements. Based upon her litigation experience, she frequently counsels clients on how to minimize, control and prevent losses. She has a proven record of accurately analyzing the value of cases, settling when appropriate and trying cases where the opponent is unreasonable.

    Admissions

    • Colorado
    • Nebraska
    • U.S. District Court, District of Colorado
    • U.S. District Court, Northern District of California

    Memberships

    • American Health Lawyers Association
    • Colorado Health Care Association
    • Colorado Bar Association
    • Denver Bar Association
    • LeadingAge

    Industry and Civic Involvement

    • Mayoral Appointment to the Mental Health Center of Denver, Board of Directors (June 2017 to present)
    • American Health Lawyers Association, Post-Acute and Long Term Services Practice Group, Social Media Chair (June 2018 to present)
    • American Health Lawyers Association, Post-Acute and Long Term Services Practice Group, Leadership Development Committee (June 2016 to June 2017)
    • Leading Age, Member of 2017 Compliance and Business Ethics Advisory Group
    • Colorado Managed Care Collaborative, Board Member, Government Policy Committee Chair  (January 2014 to December 2018)

    Languages

    Spanish

  • Practice Areas
  • Representative Experience
    • Represented healthcare facilities in government investigations conducted by the U.S. Department of Health and Human Services Office of Inspector General (OIG) and other state fraud units, such as the Colorado Medicaid Fraud Control Unit (MFCU).
    • Assisted ambulatory surgery center (ASC) in appealing to an administrative forum overpayment demands made by a Medicare Administrative Contractor (MAC).
    • Assisted employer in responding to a U.S. Department of Labor investigation.  Achieved favorable outcome by significantly negotiating a narrowed scope of the investigation with minimal fines assessed.
    • Assisted employer with establishing an employee wellness and prevention program that complies with regulatory frameworks such as GINA, ADA, ERISA, COBRA, HIPAA and the ACA.
    • Represented providers in regulatory appeals related to overpayment demands resulting from Medicare compliance audits.
    • Defended provider of rehabilitation services in False Claims Act (FCA) case alleging that services were not reasonable or necessary and did not qualify as skilled care based upon alleged inflated Resource Utilization Groups levels.
    • Advised on regulatory issues and developed policies and procedures for municipality in order to comply with HIPAA and 42 CFR Part 2.
    • Tried cases before the Departmental Appeals Board (DAB) and Civil Remedies Division (CRD) of the Department of Health & Human Services (HHS) to contest sanctions and civil monetary penalties assessed against long-term care facilities. Appealed to the Colorado Office of Administrative Courts (OAC) adverse actions against providers resulting from claimed overpayments or other allegations made by state governmental agencies. Defended healthcare professionals and organizations in government investigations before licensing boards and in other administrative proceedings.
    • Drafted, reviewed and negotiated contractual documents related to provider transactional matters such as forming corporations, advising on Medicare and Medicaid certification and reimbursement issues, and general business planning. Reviewed and negotiated physician employment and recruitment agreements with a frequent emphasis on analysis and structuring of compensation provisions.
    • Advised healthcare professionals, providers and business entities regarding Stark, anti-kickback laws and other state and federal compliance matters including fraud and abuse issues. Investigated and researched whether exceptions or safe harbors allow certain transactional agreements to be reached.
    • Drafted admissions agreements, program statements and general policies and procedures for healthcare facilities to ensure conformance with regulatory requirements. Reviewed and revised policies and procedures while working to facilitate goals of compliance departments.
    • Assisted long-term care providers in developing policies allowing or disallowing medical and/or recreational cannabis use at their facilities in light of state and federal regulatory frameworks, including advising on relevant limitations when the provider receives reimbursement in federally funded programs.
  • Publications & Presentations
    Publications
    • Author, Candor in Colorado: New Statutory Protections for Communications About Adverse Health Care Incidents, Health Care Pulse, June 27, 2019
    • Author, SAMSHA Revisions to Part 2 – A Long Time Coming for Updates to Substance Use Confidentiality, DRI Medlaw Update, July 14, 2017
    • Author, OIG Releases FY 2017 Work Plan: New Areas of Focus for Skilled Nursing Facilities, Hospices, and Home Health Agencies, American Health Lawyers Association Post-Acute and Long Term Services Health Law Email Bulletin, November 2016
    • Author, CMS Seeks to Stop Infection in Its Tracks through Modification to Infection Control Program Requirements, American Health Lawyers Association Post-Acute and Long Term Services Health Law Email Bulletin, October 2016
    • Author, CMS Releases Report on Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, American Health Lawyers Association Post-Acute and Long Term Services Health Law Email Bulletin, February 2016
    • Author, CMS Issues Final Rule Related to Medicaid Face-to-Face Requirements for Home Health Services and Implements Other Key Policy Clarifications, American Health Lawyers Association Post-Acute and Long Term Services Health Law Email Bulletin, February 2016
    • Author, OIG Checks on States’ Implementation of Background Check Programs, American Health Lawyers Association Post-Acute and Long Term Services Health Law Email Bulletin, February 2016
    • Author, CMS Revises the 5-Star Quality Metrics System for Nursing Homes, Healthcare Law Business Insights, February 2015

    Presentations

    • Speaker, How to Implement Risk Management Strategies During the COVID-19 Pandemic, Colorado Health Care Association, Denver, CO, June 2020
    • Speaker, Fundamentals of Medicare and Medicaid Reimbursement in Long-Term Care, American Health Lawyers Association, Long-Term Care and the Law National Convention, Phoenix, AZ, February 2019
    • Speaker, Drugs, Money, and Change:  What you Need to Know about the 2018 Legislative Session, Colorado Managed Care Collaborative Event, Anschutz Medical Campus, Aurora, CO, June 2018
    • Speaker, The Intersection of Law & Politics, Opioid Crisis: A Prescription for Combating Claims, Gordon & Rees Legal Education Conference, Hartford, CT and New York, NY, May 2018
    • Speaker, 2017 Colorado Legislative Session Wrap-Up, Colorado Managed Care Collaborative Event, Anschutz Medical Campus, Aurora, CO, June 2017
    • Speaker, Double Jeopardy!: Healthcare Ethics Update 2017, Gordon & Rees Legal Education Conference, Hartford, CT, May 2017
    • Speaker, The Trump Card: A Changing Legal Landscape in Healthcare, Gordon & Rees Legal Education Conference, Hartford, CT, May 2017
    • Speaker, Double Jeopardy!: Healthcare Ethics Update 2017, Gordon & Rees Legal Education Conference, New York, NY, May 2017
    • Speaker, Whistleblowers and the False Claims Act—Avoiding Ethical Pitfalls, Continuing Legal Education in Colorado Seminar, April 2016
  • Education

    Education

    J.D., University of Denver College of Law, 2001

    B.A., University of Iowa, 1998

    Honors

    The Best Lawyers in America© distinction in Health Care Law (2020-2021)

    Colorado Super Lawyers, Rising Stars (2013)

  • Languages
    • Spanish