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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.

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Our Experience

Case Study
Mintz is helping a manufacturer and distributor of device systems used in wound treatment pursue Medicare and Medicaid coverage options throughout the country, including negotiating coding. Mintz attorneys met with the Centers for Medicare & Medicaid Services (CMS) regarding scope of coverage.
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 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 Compliance with billing and coverage requirements imposed by government and commercial payors Comments on draft national and local Coverage Determinations and proposed rules

​Experience Where It Matters
  • Former general counsel for Medicaid and Medicare Programs at UnitedHealth Group
  • Former President, National Association of Medicaid Fraud Control Units (NAMFCU)
  • Former Director and Supervising Attorney, Oregon Department of Justice Medicaid Fraud Control Unit (MFCU)
  • Various personnel from Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General (OIG)
  • Former Chair, Massachusetts Rate Setting Commission

Meet Mintz

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