Government Payor Defense
Invalidated a statistical extrapolation and overturned all denied claims at an ALJ hearing with OMHA that reduced a debt from $265,000 to $2,200 and recovered all previously recouped funds and interest accrued.
Defended a oncology specialty practice from a Recovery Audit Contractor (RAC) audit on behalf of the Department of Veteran Affairs and settled alleged overpayment for reduced amount prior to completion of the audit.
Defended a CMS Medicare and Medicaid fraud, waste, and abuse audit by a Unified Program Integrity Contractor (UPIC) by reducing exposure from $6 million to $155,000.
Defended a Medicaid fraud, waste, and abuse audit and reduced exposure from $1.6 million to $300,000.
Defended a hospice owned by a health system from a UPIC audit and CMS payment suspension by reducing error rate from 88% to 3%, terminating suspension, and having held funds in the amount of $5.5M released.
Commercial Payor Defense
Defended a medical reference laboratory from a commercial insurer SIU audit and administrative appeal that reduced demand from $2.5M to $700,000.
False Claims Act and Agency Defense
Successfully defended a False Claims Act investigation against a revenue cycle management company that had billed for the targets of the Department of Justice litigation.
Defended free-standing hyperbaric facility from False Claims Act investigation and reduced exposure from $25M to $450,000 in settlement.
Successfully reduced the Department of Justice's $80 million dollar fraud loss amount to $9 million dollars.
International Reimbursement Dispute
Represent foreign hospitals and air ambulances in administrative appeals and pre-litigation resolutions for settlement of health insurance claims by foreign hospitals and air ambulance companies.
Represent U.S. hospitals and providers in administrative appeals and pre-litigation resolutions for settlement of health insurance claims against foreign insurance carriers and government health plans.