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, we assist 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.

Our Services

Epstein Becker Green provides complete legal support for health care organizations related to third-party payors. Our services include:

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