Healthcare: Government and Private Health Program Reimbursement

Our healthcare attorneys help clients navigate compliance with the healthcare payment system and address alleged overpayments, uncertain payment or coverage guidance, investigations, audits, reviews, and enforcement, as well as disputes, whether between a business and the government or between private parties.

Heavily regulated federal and state programs, complex commercial contracting structures, and a slew of acronyms and codes are some of the complex aspects of the U.S. system for healthcare payment that our attorneys deal with every day. We are experienced in representing providers, suppliers, and payors in the intricate and ever-changing landscape of the U.S. healthcare system.

For our attorneys, local and national coverage decisions are a constant occurrence, and fee-for-service, capitation, and risk adjustment structures are part of our daily routine. We assist providers and suppliers with payor contracting, provider enrollment, and other legal and regulatory matters relating to the relationship between the provider and government or commercial healthcare payor. Our attorneys regularly appear before administrative bodies and interact with government agencies, contractors, and private payors on payment-related investigations, audits, reviews, and enforcement.

Additionally, we represent a broad range of providers and managed care organizations in Medicare and Medicaid reimbursement matters, including reimbursement planning, analysis, and audits, and appear before administrative judicial bodies and federal and state courts on their behalf.