Medicare & Medicaid and Other Government Payors

Overview

Healthcare providers, physicians, and suppliers heavily rely on Medicare and Medicaid reimbursements, which constitute a significant portion of their revenue. However, the continuously evolving rules and regulations surrounding healthcare reimbursement issues pose constant challenges. Our Medicare lawyers at Nixon Peabody can partner with you to navigate this complex and fast-moving environment. Our extensive experience in Medicare litigation, coupled with our strong relationships with Medicare administrative contractors, officials in the offices of the Centers for Medicare and Medicaid Services (CMS), and state Medicaid agencies enables us to find answers quickly and achieve the right results for our clients. In the event of an audit, administrative hearing, or need to prosecute appeals, our team is experienced at standing before the Provider Reimbursement Review Board, in administrator’s review, and in judicial proceedings.

Representative experience

• Provider of home healthcare services: Assisted in restructuring operations to respond to changes under both the federal Medicare and state Medicaid programs
• Large metropolitan hospital: Represented with respect to Medicare and Medicaid billing rules and regulations
• Certified home health agency: Assisted with a Medicaid audit by the Office of the Medicaid Inspector General
• Regional medical center: Advised in connection with an internal audit related to their home health agency’s compliance with Medicare conditions of payment
• Pediatric home care agency: Resolved payment issues relating to a self-disclosure to the Office of the Medicaid Inspector General
• Health system: Advised on its administrative appeal to the California Department of Healthcare Services (DHCS) to enroll the health system’s 1206(g) medical clinic in the Medi-Cal program

Recognition

• Nixon Peabody has been named a Tier 1 National firm for Health Care Law in the 2024 edition of Best Law Firms® and in consecutive years prior; named “Law Firm of the Year” in Healthcare Law by Best Law Firms in 2016
• Named as a leading firm in Healthcare by Chambers USA in 2021; 31 healthcare lawyers ranked
• Recognized as a top law firm in Healthcare by the American Bar Association’s Health Law Section
• Ranked nationally as one of the largest healthcare firms by Modern Healthcare