National Healthcare Law

Medicare and Medicaid Reimbursement

Many partners and associates of the Nelson Mullins Healthcare Group provide advice and counsel clients with respect to reimbursement under the Medicare and Medicaid programs as well as private pay programs. These attorneys are familiar with and regularly research matters relating to such reimbursement, have handled appeals of denials of claims, and advised clients with respect to overpayments and billing errors. The Nelson Mullins Healthcare Group maintain contacts with carriers across the country as well as with the Center for Medicare and Medicaid Services ("CMS") to assist clients in resolving such matters. These attorneys maintain up-to-date information and regularly advise clients on actual or proposed changes to reimbursement policy and regulation.

Representative Experience includes the following:

• Representation of regional and national providers in matters related to Medicare reimbursement disputes before various Medicare contractors, state Medicaid agencies and the Centers for Medicare and Medicaid Services (CMS).
• Representing healthcare providers on Medicare and Medicaid policy and reimbursement changes before CMS and the OIG including matters relating to the implementation of the Medicare Part D drug benefit.
• Representing healthcare lenders in connection with investment, equity sponsorship, and syndicated lending including advising lenders regarding Medicare and Medicaid reimbursement trends, specific fraud and abuse risk issues associated with certain sectors of the healthcare industry, and regulatory due diligence.
• Providing general advice on Medicare and Medicaid billing requirements and reimbursement issues including advice regarding the structure of joint ventures (both equity and contractual) and other transactions under various federal and state laws including the Federal Anti-Kickback Statute and the Federal Physician Self-Referral or "Stark" Law.