Audits & Appeals

Our Healthcare Reimbursement attorneys handle False Claims Act and commercial insurance disputes in addition to what are now more “routine” government audits, whether by Medicare Administrative Contractors (“MACs”) or more aggressive programs, such as UPICs, SMRCs, TPE, ADRs, MICs, and RACs.  These audits and appeals require an in-depth knowledge of the government’s complex, multi-level appeals process, and an understanding of the healthcare and technical regulatory issues underlying the audits. Although we handle these audits and appeals daily, they are by no means routine for our clients, who may be facing an audit for the first time and may have hundreds of thousands or even millions of dollars at stake.

We handle all aspects of administrative hearings. We challenge statistical sampling and extrapolation by payors, perform medical record reviews, retain experts, and prepare our clients’ witnesses to testify. We also help navigate the government’s various settlement initiatives and fight prepayment audits and exclusions.