Dealing effectively with the Medicare program requires careful use of appropriate strategies.

Powell Goldstein provides a strong array of services to our clients involving the Medicare Program. We provide a full range of legislative advocacy; regulatory advocacy; representation before the Centers for Medicare and Medicaid Services (CMS), the Medicare carriers, the DME MACs, the fiscal intermediaries, the SADMERC and the National Supplier Clearinghouse; assistance with coverage, reimbursement and coding issues; litigation; claims appeals; and fraud and abuse compliance plans and strategies. Our broad range of clients has enabled us to develop effective strategies involving nearly every aspect of the Medicare Program and settings of care.

Our clients in the Medicare area include hospitals (involving both inpatient and hospital outpatient department issues); manufacturers of medical devices and pharmaceuticals; Part B suppliers of durable medical equipment, home infusion drug therapies, parenteral and enteral nutrition and orthotics; independent diagnostic testing facilities; nursing homes and suppliers to nursing homes; telemedicine companies; pharmacies; physician practice management companies; the cancer community; and biotechnology companies.

Representative Matters:

• Developed and implemented strategies to establish and protect Medicare policies involving coverage, coding and reimbursement
• Created and implemented strategies to effectuate change in Medicare policy at the national level, representing our clients and coalitions before the U.S. Congress, the Administration, the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS)
• Worked successfully with Medicare contractors and CMS regional offices to change policies at the local and regional levels, including representations before the local carriers, the DME MACs, the SADMERC, the fiscal intermediaries and the National Supplier Clearinghouse
• Assisted hospitals in reimbursement issues involving both inpatient care and care provided in hospital outpatient department settings
• Assessed regulatory issues and provided our clients with guidance in interpreting and complying with Medicare's rules with respect to their daily operations, contractual arrangements with referral sources, changes in ownership and interactions with other health care entities
• Provided strategic and legal advice in the interpretation and compliance with the laws and regulations involving fraud and abuse
• Performed litigation and claims appeals to support our clients' interests