Our payments and reimbursement attorneys have extensive experience with a variety of public and private payment systems. We provide representation in navigating complex nongovernmental payment methodologies, negotiating contracts, and resolving underpayment and overpayment disputes. Our services include:

  • Representing individual providers and groups in appeals before the Medicare PRRB and in federal trial and appeal courts, including appeals concerning DSH, GME, IME, bad debts, wage index adjustments, provider tax, and TEFRA
  • Representing health care providers in the resolution of public and private payment system disputes through mediation and arbitration
  • Prosecuting Medicaid appeals in state administrative hearings
  • Defending providers in audit overpayment determinations by MACs, RACs, state program integrity units, and private payers
  • Advising in connection with revenue cycle procedures, billing practices, coverage issues, and other aspects of payment compliance
  • Providing counsel concerning the 340B program and the cost principles governing PHS grants

Firm Highlights


State Medicaid Audits

Defended numerous state Medicaid audits alleging substantial overpayments, including a $3.6 million alleged overpayment resolved for $350,000 and a $530,000 alleged overpayment settled for $823, among others.


Graduate Medical Education

Obtained multi-year addition to teaching hospital's Graduate Medical Education cap and Medicare reimbursement through appeal to the PRRB.


Medicare Appeal—$27 Million Recovery

Worked on behalf of two related teaching hospitals in multiple appeals of Medicare disallowances filed before the PRRB covering multiple fiscal years, culminating years of work in a full and complete settlement with our...


Reasonable Cost Reimbursement

Persuaded CMS to agree that a certain type of allied health residency program met the Medicare criteria for "reasonable cost" reimbursement.


Overpayment—Physician Practice

Worked with a physician practice in an alleged overpayment of over $400,000, resolving the matter with a payment of only $30,000.


Medicare Appeal—$6 Million Recovery

Represented a large hospital before the PRRB covering four fiscal years, resulting in over $6 million of additional Medicare reimbursement to the hospital.


Medicare Appeal—$33.5 Million Recovery

Represented group of 19 hospitals in appeals before the PRRB involving over 120 fiscal years, resulting in on-going settlements worth approximately $33.5 million.


Standardized Amount Appeal

Engaged by several large health systems to pursue the "standardized amount" appeal on their behalf at the Medicare Provider Reimbursement Review Board (PRRB), either through group appeals where allowed, or through individual appeals.


Medicaid Appeal—$95 Million Recovery

Developed and prosecuted coordinated Medicaid appeals and litigation on behalf of a group of hospitals that resulted in a landmark settlement of approximately $95 million with the State.



Investigated and reported a Medicare overpayment to the Centers for Medicare & Medicaid Services (CMS) on behalf of a federally qualified health center.

Contact Verrill at (855) 307 0700