PAYOR CONTRACTING AND AUDITS

Wade Goldstein’s attorneys advise healthcare providers and medical practices on a wide range of reimbursement and payor-related matters. This includes negotiating and structuring participation agreements with third-party payors, including Medicare and commercial insurance companies, and counseling clients on the operational and regulatory implications of those arrangements. Our attorneys also assist providers in responding to payor audits, investigations and reimbursement disputes, and guide clients through internal compliance reviews and appropriate disclosures when potential billing or regulatory issues are identified. Our firm’s approach focuses on helping healthcare organizations navigate complex reimbursement frameworks while reducing regulatory risk and maintaining operational continuity.

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Representative Services:

• Reviewing payor contracts to ensure favorable terms and compliance

• Negotiating reimbursement rates and payor contracts

• Advising on managed care contracts

• Defending against payor audits and investigations