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Coverage and payment issues in the health care industry are extremely complex for many health care organizations. Epstein Becker Green has decades of experience representing health care clients in third party coverage, coding and payment/reimbursement issues from state and federal governmental sources. The firm has many attorneys with in-depth knowledge about all types of government health programs.

At the federal level, Epstein Becker Green assists clients with a full spectrum of federal health program issues including Medicare, Medicaid, TriCare (CHAMPUS) and the Federal Employees Health Benefits Program. At the state level, Epstein Becker Green assists clients with state Medicaid and other state rate-setting matters, state payor systems and other state programs such as high risk pools for the chronically ill.

Epstein Becker Green's Government and Commercial Reimbursement Group is comprised of attorneys who focus on government program coverage, coding and payment/reimbursement matters; qualification for participation in federal and state health programs; and obtaining facility licenses and/or certificates of need. Attorneys also are available to counsel clients in the requirements for operating and delivering health services to governmental programs. We also assist clients in maintaining corporate compliance with these highly regulated health programs.

Epstein Becker Green provides complete legal support for health care organizations related to third party payors, including:

  • representation before the Medicare Program, the Medicaid Program, TriCare (CHAMPUS), the Federal Employees Health Benefits Program and the U.S. Public Health Service;
  • representation before state rate-setting boards, state payor systems;
  • due diligence counsel to determine a health care organization's compliance with government health program requirements;
  • legal counsel for qualification submissions for participation in federal and state health programs;
  • document preparation and submission for state facility licenses and certificates of need;
  • comprehensive legal services regarding participation requirements in government health programs, including participation in the MedicareAdvantage Program and Medicaid managed care programs;
  • appeals of payment denials and overpayment determinations for providers and suppliers under all government health programs;
  • legal reviews of new and proposed corporate structures for impact on eligibility for government payments;
  • litigation of disputed denials and payment methodologies;
  • pharmaceutical rebate and discount issues, under state and federal rebate laws, including the Medicaid Drug Rebate Act/Veterans Health Care Act; and
  • representation in connection with coverage, coding and payment issues for new drugs, devices or services.