Attorneys at Powers Pyles Sutter & Verville have considerable experience advising hospitals, physicians, nursing homes, home health agencies, DME suppliers, and others regarding all aspects of healthcare reimbursement and coverage.

Federal healthcare programs, including Medicare and Medicaid, constitute the largest purchasers of healthcare services in the country; therefore, issues of reimbursement and coverage under these programs are of critical importance to healthcare providers. The complexity of the federal Medicare and Medicaid regulatory schemes demands attorneys with extensive experience and technical expertise. We pride ourselves on our thorough knowledge of the intricacies of these multifaceted programs, our grasp of the broader implications of reimbursement issues and our ability to develop creative solutions to the challenges facing our clients.

Our knowledge and perspective come from our long experience in this practice area. Powers was founded in 1983 as a healthcare law firm focused principally on Medicare and Medicaid reimbursement and coverage issues. Our attorneys have handled significant cases before administrative agencies, as well as state and federal courts across the country, including the U.S. Supreme Court.

Healthcare providers of every size and description, as well as physicians and non-physician healthcare practitioners, look to Powers for solid, grounded advice on the full range of issues related to Medicare reimbursement and coverage matters, including issues related to CMS demonstration projects. Powers attorneys also have broad experience with federal and state Medicaid program requirements related to reimbursement, eligibility, and coverage. We assist clients to present captured clinical care data and related information to support coverage of new types of services, practice modalities and innovative procedures that improve the provision of care.

Our attorneys advise clients with issues related to the Medicare Advantage program, including assistance with application procedures and interpretation of contract requirements. We represent healthcare entities operating coordinated care plans, and have worked with them to achieve compliance with contractual obligations and applicable federal statutes, regulations and policies.

Attorneys in the reimbursement department work closely with other subject matter experts in our firm, including attorneys in the drug pricing, nonprofit tax and fraud and abuse practices, to ensure that our clients have a full understanding of how a proposed solution will affect their operations. We also work with attorneys in our advocacy group to bring our clients’ concerns to federal and state legislatures and regulatory agencies.

Download PDF