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Fraud & Abuse Audits and Investigations

Whether you are proactively auditing your billing practices or have been accused of fraud or abuse by a third-party payor or government entity, our team will work with you to respond to investigations, audits or subpoenas and provide compliance advice to minimize risk.

Our Approach

The health care industry is under constant scrutiny by state and federal agencies and third-party payors.  Our team understands the need to have passionate, deeply knowledgeable representation, as early as possible. We represent health care providers and others in the health industry against claims of fraud and abuse and through audits and investigations, and defend them before r state and federal agencies and regulatory bodies. Because our team members have worked in the Attorney General’s office, we understand the strategies that are taken and can work to develop the best approach for your situation. In addition, we also provide counseling on the front-end, helping you develop compliance programs to avoid future issues. We have a special focus on representing providers in audits, arbitrations and other payor-provider relations with third-party payors.

Clients Include

• Physician groups
• Behavioral health providers
• Mental health providers
• Home health care organizations and systems
• Assisted living facilities
• Senior living operators and owners
• Trade associations
• Pharmacies and specialty pharmacies
• Pharmacy benefit managers
• Dentists and specialists

Focus

• Civil investigative demands
• Medicare and Medicaid audits
• False Claims Act
• Anti-Kickback Statute
• Stark
• Fraud and abuse compliance programs
• DEA Enforcement
• Third-party payor audits

Notable Experience

• We have represented hundreds of health care providers in conjunction with public and private third-party payer fraud, waste and abuse audits, investigations and enforcement litigation, as well as false claims act cases.<br />
• Challenged a six figure overpayment demand from a health insurer, demonstrating that the extrapolation method used was fundamentally flawed, which resulted in the insurer withdrawing the overpayment demand in its entirety.
• Represented a large behavioral health provider in connection with a four year long federal False Claims Act investigation, involving tens of millions of dollars in alleged false claims and the production of hundreds of thousands of documents in response to a Civil Investigative Demand, which ultimately resulted in the Department of Justice declining to pursue the matter and the eventual dismissal of the underlying <i>qui tam complaint</i>.
• Represented a clinical laboratory in connection with a Medicaid overpayment demand based upon alleged improper claims documentation and billing for confirmatory urine drug screens; successfully settled the matter with the Department of Human Services for pennies on the dollar of the original demand based largely upon faulty statistical extrapolation methods.

Dedicated Attorneys and Professionals

Shareholder

David M. Aafedt P / 612.604.6447 E / [email protected]

Shareholder

Christianna L. Finnern P / 612.604.6435 E / [email protected]

Shareholder

Elizabeth H. Schmiesing P / 612.604.6528 E / [email protected]

Counsel

Tracy L. Jacobs P / 612.604.6499 E / [email protected]