Our team of nationally recognized practitioners with deep experience in Medicare and Medicaid systems and strong ties to the Centers for Medicare & Medicaid Services (CMS) advises hospitals and health systems on Medicare and Medicaid reimbursement strategy, financing, compliance, and disputes, helping them improve their reimbursement outcomes and respond to complex regulatory developments.

We advise hospitals and health systems on tactical decisions that enhance their government reimbursement, such as provider-based department restructuring, graduate medical education planning and geographic wage and rural/urban reclassification decisions. Our team also designs and executes coverage, coding, and payment strategies at both the federal and state levels. We have helped providers recover more than a billion dollars and avoid significant alleged overpayments through disputes resolved by negotiation, mediation, arbitration, litigation, and settlement.

We secured major reimbursement litigation victories in federal court including Citrus LLC v. Becerra, Bethesda Health v. Azar, Milton S. Hershey Medical Center v. Becerra, and Baylor All Saints et al. v. Becerra resulting in changes to CMS policy in inpatient rate setting rules and increased client reimbursement by hundreds of millions of dollars. We also partner with providers to form coordinated litigation coalitions to challenge agency action, such as our representation of more than 50 teaching hospitals in the fellow penalty appeal issue. In addition, we help clients respond to evolving regulatory requirements by developing practical, collaborative solutions.

Our Medicaid reimbursement and financing team advises hospitals and health systems across the country on the full spectrum of Medicaid payment and financing issues. Our team helps clients design, implement, finance, and effectively administer their participation in Medicaid supplemental payment programs, including Medicaid Disproportionate Share Hospital (DSH) programs, incentive and waiver programs, state directed payment (SDP) programs, and fee-for-service supplemental payment arrangements. Our team routinely advises hospital clients on developments in federal and state law that impact Medicaid reimbursement and financing mechanisms, and the broader implications for hospital financing strategies. Our team helps hospitals navigate these changes through financial modeling, strategic planning, new program and financing proposals, comment preparation, and advocacy before state and federal agencies. Using their intricate knowledge of government payment programs, our Medicaid team also assists hospital systems to litigate disputes with managed care organizations and to navigate government investigations into billing practices and related issues.