Health Care Reimbursement

Systemic events have prompted unprecedented changes to health care reimbursement regulations, making them more complicated than ever. As one of the longest-standing reimbursement practices in the country, we have extensive experience challenging Medicare, Medicaid and other federal program reimbursement denials.

Our lawyers regularly represent hospitals and other providers individually and in group appeals in reimbursement challenges before administrative tribunals and in federal court. Our practice includes lawyers who previously served in the Office of the General Counsel of the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ).

Through the development of creative approaches to novel issues, we have obtained notable successes in several cases of first impression:

The first and only decision nationwide, holding that a generally overlooked provision of the Medicare Act requires notice-and-comment rulemaking even when the Administrative Procedure Act (APA) otherwise would not require it.
The first national lead case on the rural floor budget neutrality adjustment to the Prospective Payment Systems (PPS) rate per discharge.
The first federal appellate decision overturning the retroactive application of a 2004 change in policy on counting Medicare + Choice (M+C) days in the disproportionate share hospital (DSH) calculation.
The national lead case on mandamus claims requiring HHS to reopen and revise prior erroneous DSH payment determinations excluding Medicaid eligible, but unpaid, days.

We prosecute nearly every type of Medicare appeal from the administrative level through the federal appellate courts—but we are committed to delivering value to clients and recognize extended litigation is not always necessary or the best course. We counsel our clients to maximize the prospect of avoiding disputes and settling their appeals.

With the support of one of the largest public policy practices in the country, we also, when appropriate, develop multipronged strategies for resolving complex payment issues, including mobilizing congressional delegations and engaging leaders of the executive branch.