Experience

Wiggin and Dana's recent experience in regulatory compliance and reimbursement matters includes the following:

  • Served as lead counsel in a multi-prong administrative and court challenge to state's Medicaid reimbursement system for hospitals.
  • Obtained a certificate of need and Attorney General's Office approvals for conversion of a nonprofit health system.
  • Obtained a temporary restraining order in federal court to avert termination of a home health care client, leading to negotiation of a favorable CMS settlement.
  • Served as state health care regulatory counsel in dozens of nationwide and regional transactions and financings, including transactions effectuating changes of ownership.
  • Drafted and advised on hospital Medicaid reimbursement and provider tax legislation, as well as legislation governing audits of Medicaid providers.
  • Represented a physician practice in unraveling Medicare, Medicaid, and other payor-enrollment issues.
  • Negotiated statewide settlement of hospital audits involving Medicare cost-sharing payments.
  • Secured $3 million in reimbursement for a long-term care client following a win over the state in the first Medicaid rate hearing in over 15 years.
  • Navigated a mental health mobile provider through deactivation of its Medicare enrollment number, resulting in a favorable settlement for the provider.