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.
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 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.
Behavioral health providers
Mental health providers
Home health care organizations and systems
Assisted living facilities
Senior living operators and owners
Pharmacies and specialty pharmacies
Pharmacy benefit managers
Dentists and specialists
Civil investigative demands
Medicare and Medicaid audits
False Claims Act
Fraud and abuse compliance programs
Third-party payor audits
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</i> complaint.
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.
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