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Regulatory Appeals

In the highly regulated healthcare environment, providers frequently encounter adverse decisions from state and federal agencies, ranging from Medicare and Medicaid payment denials to licensing sanctions and other enforcement actions. With an in-depth understanding of the complex administrative landscape, requirements and legal precedents needed to effectively challenge unfavorable regulatory determinations, Greenbaum provides comprehensive legal services dedicated to representing healthcare providers in regulatory appeals.

We represent clients in state regulatory appeals before the Office of Administrative Law, New Jersey Superior Court, Law and Appellate Divisions, and the New Jersey Supreme Court. Our work includes the defense of licensed healthcare professionals in appealing adverse decisions related to license suspension, revocation, probation or fines handed down by New Jersey's various professional licensing boards, including the Board of Medical Examiners (BME), Board of Nursing, and Board of Pharmacy.

We assist clients with appeals related to the denial of license reinstatement applications. In addition, we represent healthcare facilities and providers in challenging adverse decisions by the New Jersey Department of Health regarding the issuance or denial of Certificates of Need for new facilities, services, or significant capital expenditures, and handle administrative agency appeals from other state and federal healthcare-related agencies that impact a provider's operations, such as those related to facility licensure, surveys, or regulatory compliance penalties.

Greenbaum is a leading resource for Medicare and Medicaid reimbursement appeals, including overpayment appeals, medical necessity denials, coding and billing disputes, and enrollment and credentialing denials. We assist a wide range of healthcare entities and professionals in challenges to adverse regulatory determinations, including hospitals and health systems, physician practices, ambulatory surgical centers, long-term care facilities, home health agencies, pharmacies, and individual licensed professionals.

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