Skip to main content

Medicare, Medicaid & Commercial Coverage & Reimbursement

Pursuing & Defending Your Government Reimbursement

The regulatory and contractual requirements governing health care reimbursement and coverage are increasingly complicated. Payments from governmental sources and commercial payors are critical to the health care industry, and any threat of reduced payment is a direct hit to the bottom line. Our Mintz team has deep experience counseling clients on Medicare, Medicaid, managed care, and commercial payor reimbursement issues.

Sign up for insights

Share Awards

Our Experience

Case Study
Mintz secured a full release of a biopharmaceutical company in a Louisiana state court case over alleged inflated drug price reporting. The client agreed to a nuisance value settlement of the case, resolving claims its actions cost the state’s Medicaid program more than $20 million.

Our Approach

Our health law attorneys provide advice on the full spectrum of issues related to participation in government health care programs — Medicare (Parts A, B, C, and D), Medicaid, TRICARE, the State Children’s Health Insurance Program, the Federal Employees Health Benefits Program, and third-party managed care and commercial payor networks. We counsel providers on complex Medicaid matters and other state rate-setting matters.

We have a uniquely integrated reimbursement and FDA team. Our attorneys guide clients with new drugs, devices, and products on coverage, coding, and payment pathways while looking around the corner at potential FDA approval pathways. Many of these elements are distinct, but none should be considered in a vacuum.

​Service Areas
  • Commercial payor audits and overpayment assessments
  • Compliance with billing and coverage requirements imposed by government and commercial payors
  • Comments on draft national and local Coverage Determinations and proposed rules
  • Government investigations and litigation involving Medicare and Medicaid reimbursement issues, including matters before the Provider Reimbursement Review Board, Departmental Appeals Board, and state and federal courts Coverage, coding, and payment for new products, drugs, and devices
​Experience Where It Matters

Our team includes various personnel from Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General (OIG), and the former General Counsel of America’s Health Insurance Plans (AHIP)

Meet Mintz

Our team has deep experience counseling clients on Medicare, Medicaid, managed care, and commercial payor reimbursement.