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Medicare & Medicaid and Other Government Payors

Related Practices

Rankings & Honors

  • U.S. News/Best Lawyers has named Nixon Peabody “Law Firm of the Year” in Health Care Law in 2016
  • “Deal of the Year” for Health Care Financing by The Bond Buyer for Presence Health Network 2016 bond offering
  • Ranked nationally in U.S. News/Best Lawyers “Best Law Firms” in Health Care Law and received metropolitan rankings in Health Care Law in Albany, Boston, Chicago, Los Angeles, New York City and Rhode Island
  • Ranked in Illinois, Massachusetts and New York for Healthcare in Chambers USA: America’s Leading Lawyers for Business
  • Ranked nationally by Modern Healthcare—Largest Healthcare Law Firm
  • Recognized lawyers by Best Lawyers in America in the field of Health Care law
  • Recognized lawyers by Super Lawyers in the area of Health Care law
  • Recognized by the American Bar Association’s Health Law Section in its Annual Regional Law Firm Recognition Program
  • Recommended in The Legal 500 United States 2016


We leverage our knowledge and relationships to optimize our clients’ opportunities and minimize their risks under Medicare, Medicaid and other government payment programs, guiding them through the evolution of payment reform.

Our Approach

We provide our health care clients with reimbursement advice under the Medicare and Medicaid programs as well as third-party payor managed care contracts, including issues relating to cost reporting, billing compliance and self-disclosures, revenue enhancement and transaction structuring.

Our working relationships with Medicare Administrative Contractors, officials in the regional and central offices of the Centers for Medicare and Medicaid Services (CMS), as well as state Medicaid agencies help us to find answers quickly and achieve the right results for our clients.

Medicare reimbursement services

  • Change of Ownership (CHOW)
  • Provider-based designations
  • Direct and indirect graduate medical education payments
  • 340B Pharmacy Discount Program qualification
  • Disproportionate Share Hospitals
  • Consolidated billing
  • Reassignment rules
  • “Incident to” billing rules
  • Specialty Hospital and Specialty Unit reimbursement
  • Geographic reclassification
  • Wage Index
  • Critical Access Hospitals
  • Sole Community Provider status
  • Timely claims processing issues
  • Rate adjustments and exceptions
  • Third-party liability recovery issues
  • Discrete costing and cost allocation issues
  • PRI/MDS/RUGS case mix issues

Medicaid reimbursement services

  • Certification and Change of Ownership (CHOW)
  • Overpayments, underpayments, recoupments and offsets
  • Contract review/negotiation
  • “Medical Necessity” determinations and claims disallowance appeals

We represent clients in connection with Medicare and Medicaid audits (including RAC, ZPIC and OMIG audits) and administrative hearings and prosecute appeals for individual and groups of providers before the Provider Reimbursement Review Board and in Administrator’s Review and judicial proceedings.

We work with

  • Accountable Care Organizations
  • Health care networks
  • Hospitals
  • Clinics
  • Ambulatory surgery centers
  • Physicians and practice groups
  • Nursing homes
  • Assisted living
  • Adult day care programs
  • Home health agencies
  • Dialysis providers
  • Durable medical equipment (DME) suppliers
  • Ambulance and ambulette companies
  • Pharmacies and laboratories
  • Behavioral health providers
  • Substance abuse providers


  • Ranked in New York and Massachusetts for Healthcare in Chambers USA: America’s Leading Lawyers for Business
  • Ranked nationally in Legal 500 USA—Industry focus: Healthcare
  • Ranked nationally in U.S. News/Best Lawyers “Best Law Firms” in Health Care Law and received metropolitan rankings in Health Care Law in Albany, Boston, New York City and Rhode Island
  • Ranked nationally by Modern Healthcare—Largest Healthcare Law Firm
  • Best Lawyers in America in the field of Health Care law
  • Super Lawyers in the area of Health Care law

Media Clips

  • DSRIP: NY Medicaid Program's Transition to Value Based Payment Arrangements
    NYSBA Health Law Journal | September 1, 2016
    A team of health care attorneys including partners Laurie Cohen and Michael Taubin and associate JoAnna Nicholson authored this column discussing the Delivery System Reform Incentive Payment (DSRIP) program and its efforts to transform the New York Medicaid system.


21st Century Cures Act provides relief to qualifying hospitals with off-campus outpatient departments
Health Care Alert | January 3, 2017

Medicare updates address Section 603 of the Bipartisan Budget Act of 2015 and the NOTICE Act
Health Care Alert | December 15, 2016

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U.S. District Court finds nursing home pre-dispute arbitration agreements lawful
Health Care Alert | November 17, 2016

CMS's CY2017 OPPS rule: payments for off-campus departments
Health Care Alert | November 7, 2016

Medicare's CY2017 rates and payment policies for hospital outpatient departments and ambulatory surgery centers
Health Care Alert | November 4, 2016

MACRA Quality Payment Program Final Rule provides a more definitive path for transformed Medicare payments
Health Care Alert | October 18, 2016

Bayou Shores decision is a reminder that, in a fight with CMS over Medicare/Medicaid reimbursement, successful restructurings require advice of experienced health care counsel
Distressed Health Care Alert | August 9, 2016

Renewed focus on managed care, program compliance in the OMIG's newly released 2016–17 work plan
Health Care Alert | May 12, 2016

MACRA Proposed Rule: CMS presents a flexible approach that steers clinicians toward alternative payment models
Health Care Alert | May 5, 2016

Medicare Revalidations: Improvements and Cautions
Health Care Alert | February 26, 2016

CMS provides much needed clarity regarding "60-Day Overpayment Rule"
Health Care Alert | February 12, 2016

CMS releases draft Quality Measure Development Plan (MDP) for comment
Health Care Alert | January 7, 2016

ACOs—the leading model for care transformation
Health Care Alert | June 10, 2015

Proposed rules signal overhaul in fraud and abuse regulations governing Medicaid managed-care plans
Health Care Law Alert | June 1, 2015

Congress passes "doc payment fix" and authorizes expanded access to and uses of Medicare claims data
Health Care Alert | April 17, 2015

OMIG reminds providers that compliance officer must be an employee of the provider
Health Care Alert | April 17, 2015

Amendment to New York's telehealth legislation
Health Care Alert | March 27, 2015

New York health insurers and state Medicaid program to cover telehealth services
Health Care Alert | January 5, 2015

CMS releases revised 855R Application for Reassignment of Medicare Benefits
Health Care Alert | December 2, 2014

Special Marketplace enrollment for COBRA participants and new COBRA forms
Benefits Alert | June 4, 2014

New York's surprise medical bill law
Health Alert | June 3, 2014

CMS announces Open Payments (Physician Payment Sunshine Act) registration date for physicians and teaching hospitals
Health Care Fraud Investigations & Enforcement Alert | May 5, 2014

CMS extends the 2013 Medicare EHR attestation deadline for eligible professionals to March 31, 2014 and offers some hospitals the ability to attest retroactively for 2013
Health Law Alert | February 7, 2014

Bundled payments are here to stay: introduction of a permanent Medicare Program and increased adoption by commercial payors and self-insured employers
Health Alert | January 27, 2014

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