Regulatory and Reimbursement

With decades of experience in navigating the complexities of health care regulation and payment methodologies, the attorneys in Wiggin and Dana’s Regulatory Compliance and Reimbursement Practice Group represent clients across the health care industry. We counsel hospitals, academic medical centers, nursing homes, home health care agencies, hospices, physicians, dentists, psychiatric facilities, substance abuse treatment providers, clinical laboratories, pharmacies, dialysis providers, imaging companies, and other health care clients on all aspects of regulatory compliance and reimbursement, including:

• Certificate of need, licensure, and accreditation
• Medicare and Medicaid certification and enrollment
• Fraud and abuse analysis, including the Stark Law and Anti-Kickback Statute as well as related state laws
• State and federal surveys and inspections, including dispute resolution and appeals
• Change of ownership (CHOW) process
• Provider-based rules
• Reporting requirements
• Regulatory and reimbursement considerations involved in business planning, mergers and acquisitions, corporate restructuring, and finance
• Policy, legislative, and regulatory issues involving health care regulatory compliance and reimbursement matters
• Technical billing, coding, and reimbursement rules
• Medicare secondary payor rules
• Graduate medical education
• Compliance, false claims, and government audits and civil, criminal, and administrative investigations relating to billing and reimbursement
• Dispute resolution and litigation involving reimbursement issues before state and federal contractors, Medicare Advantage Organizations, regulatory agencies, and courts

In addition, as counsel to several national, regional, and state trade associations, we provide insights on regulatory and reimbursement policy matters.