Overview
Coverage and payment issues in the health care industry are extremely complex for many organizations. Epstein Becker Green has decades of experience representing health care clients in third-party coding, coverage, and payment/reimbursement issues from state and federal governmental sources.
We have many attorneys with in-depth knowledge about all types of government health programs. At the federal level, we assist clients with a full spectrum of federal health program issues, including Medicare, Medicaid, Tricare (formerly known as CHAMPUS), and the Federal Employees Health Benefits (FEHB) 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.
Our Government and Commercial Coding, Coverage, and Payment Group consists of attorneys who focus on government program coding, coverage, and payment/reimbursement matters; qualification for participation in federal and state health programs; and obtaining facility licenses and/or certificates of need. We also counsel clients on the requirements for operating and delivering health services to governmental programs and assist clients in maintaining corporate compliance with these highly regulated health programs.
Services to Meet Your Needs
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, the FEHB 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 coding, coverage, and payment issues for new drugs, devices, or services.
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- Publications
In Genesis Case, South Carolina District Court Scraps HRSA Interpretation of “Patient” Under 340B Statute
9 minute read - Firm AnnouncementsEpstein Becker Green Announces 2024 Promotions6 minute read
- PublicationsQuadrivalent Vs Trivalent Influenza Vaccines: Not A Simple Switch2 minute read
- Media CoverageRachel Snyder Good Quoted in “'Devil's in the Details' of Biden's AI Health Plans, Experts Say”3 minute read
- PublicationsThe Task Force’s Latest PrEP Recommendation for HIV Is Just More of the Same2 minute read
- Media CoverageRichard Hughes Quoted in “Coverage, Supply Issues Dampen Promise of New RSV Immunizations”3 minute read
- PublicationsCMS Seeks Stakeholder Feedback About Medicare Transaction Facilitator Services for the Medicare Drug Price Negotiation ...4 minute read
- Media CoverageRichard Hughes Quoted in “An R.S.V. Shot for Infants Is in Short Supply. Here’s What to Know”4 minute read
- Media CoverageRichard Hughes Quoted in “Webinar Highlights Recommendations to Improve Disparities in CRC Screening”3 minute read
- Media CoverageRichard Hughes Quoted in “RSV Vaccines Aren’t Covered by Medicare for These Vulnerable Groups”2 minute read
- PublicationsCalifornia Enacts Statute That Furthers Efforts to Move Toward a Unified Health Care Financing System11 minute read
- Media CoverageRichard Hughes Quoted in “Opinion: It Shouldn’t Be So Hard for Older Adults to Receive the RSV Vaccine”2 minute read
- Media CoverageLesley Yeung Quoted in “Doctors Question Medicare Quality Program as More Face Steeper Penalties”2 minute read
- Media CoverageHelaine I. Fingold Quoted in “The Medicare Advantage Marketing Problem and Where It’s Headed”3 minute read
- Media CoverageHelaine Fingold Quoted in “Reports of Cold Calling, False Promises Put Medicare Marketers on Alert”3 minute read
- Media CoverageRobert Wanerman Quoted in “Fight Over Medicare Pay Hinges on Primary Care”4 minute read
- Media CoverageRichard Hughes Quoted in “Federal Watchdog: One Quarter of HIV-Positive Medicaid Enrollees Missed Care”3 minute read
- PublicationsRichard Hughes, Devon Minnick Discuss Reforms of the US Preventive Services Task Force’s Processes3 minute read
- Media CoverageRichard Hughes Quoted in “New RSV Vaccines Aren’t Covered by Some Health Insurance Plans”3 minute read
- Media CoverageRichard Hughes Quoted in “Preventive Services Recommendation May Not Increase Injectable PrEP Access”3 minute read
- Media CoverageEpstein Becker Green Update Cited in “Physicians Could Be in Financial Danger with This Stark Law Change”2 minute read
- Media CoverageRobert Wanerman Quoted in “Hospitals Push Back on Safety-Net Payment Cuts”3 minute read
- Publications‘Vaccines for Children’ at 30: Lessons in Bipartisanship and Cooperative Federalism3 minute read
- Media CoverageHelaine Fingold Quoted in “2022 Medicare Advantage Audit Report Reflects Modest Penalties, Familiar Failures” ...3 minute read
- BlogsTAKE TWO: CMS’s Second Attempt to Streamline Breakthrough Device Coverage Limited to 5 Devices Per Year26 minute read
- PublicationsInsult to the Injured: The Case for Modernizing Vaccine Injury Compensation2 minute read
- Media CoverageRichard Hughes Quoted in “Lawsuit Against Affordable Care Act Targets PrEP”4 minute read
- Media CoverageRachel Snyder Good Featured in “The Top Mid-Law People Moves of 2023 So Far”2 minute read
- PublicationsCMS Announces the Making Care Primary Model, a Multistate Initiative to Strengthen Primary Care9 minute read
- Media Coverage
Richard Hughes Featured in STAT First Opinion Podcast, “How to Save PrEP Access — and Even Expand It”
3 minute read - Media Coverage
Robert Wanerman Quoted in Decoding Medicare: 10 Key Decisions and How They’re Made
4 minute read - PublicationsVaccines Deserve Immunity from the IRA’s Pricing Provisions2 minute read
- PublicationsCMS Releases Its List of 43 Part B Rebatable Drugs for Q3: Inflation Reduction Act Updates7 minute read
- PublicationsManufacturers Must Request Small Biotech Exception by July 3: Inflation Reduction Act Updates4 minute read
- Media CoverageRichard Hughes Quoted in "HIV Prevention Drug Uptake Threatened in Obamacare Battle"2 minute read
- Publications
How to Protect PrEP Coverage, No Matter What Happens in Braidwood v. Becerra
3 minute read - PublicationsBy Leaving "Therapeutic Alternatives" Undefined, CMS Tilts the Playing Field of Drug Price Negotiations3 minute read
- Media CoverageHelaine Fingold Featured in “The 2024 Final Rule: Insights from a Medicare Marketing and Compliance Attorney” ...2 minute read
- Media CoverageWill Walters Quoted in “Senators Pull Few Punches at PBM Execs During Insulin-Cost Hearing”2 minute read
- PublicationsCMS Issues an Information Collection Request for the Drug Price Negotiation Process: Inflation Reduction Act Updates ...3 minute read
- BlogsCMS Forwards Its Health Equity Agenda Through Its Annual Prospective Payment System Rulemaking Process5 minute read
- Media CoverageRichard Hughes Quoted in “Could Government Drug-Price Negotiations Sound the Death Knell for Biotech Stocks?” ...3 minute read
- Media CoverageRichard Hughes Quoted in “Biden's Next Steps on Preventive Services Coverage”3 minute read
- PublicationsIs CMS Ignoring the Realities of Biopharmaceutical Costs?2 minute read
- PublicationsCMS’s Initial Guidance on Medicare Drug Price Negotiation Program Suggests Familiar Pharmacy Chargeback Process ...12 minute read
- Publications
Repairing the US Preventive Services Task Force After Braidwood v. Becerra
2 minute read - Media CoverageRichard Hughes Quoted in “ACA Ruling Could Mean Narrowed Benefits from Health Plans”3 minute read
- Media CoverageHelaine Fingold Quoted in “CMS Rule Finalizes Marketing Changes, Leaves Out Ban on Sharing Beneficiary Contact Info” ...3 minute read
- PublicationsFederal Judge in Texas Strikes Down ACA's Preventive Services Coverage Mandate12 minute read
- BlogsIs CMS Ignoring the Realities of Biopharmaceutical Costs?6 minute read