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The Firm successfully defended a Chiropractor against allegations that the Chiropractor had engaged in billing fraud and used inadequately trained personnel to provide certain services. The Firm investigated the allegations at issue and prepared a response to the investigative complaint that highlighted evidence that demonstrated that the Chiropractor had acted properly, had not engaged in Read more →

The Firm successfully defended our LMHC client against allegations that the LHMC engaged in unprofessional conduct; misdiagnosed a client; and engaged in excessive UA testing.  This result is especially notable because the complaint at issue was initiated by a competing provider in the community. The Firm investigated the allegations at issue and prepared a rebuttal Read more →

After submitting a detailed redetermination appeal on behalf of our client’s medical practice, the Firm secured a significant reduction in the overpayment demand – more than a 95% reduction.  In addition to addressing the support for the billed services found in the relevant medical records, the Firm also addressed the statistical sampling methodology used by Read more →

In a 2-1 Decision, the D.C. Circuit Court of Appeals reversed the district court’s order to HHS to clear the backlog of administrative appeals within four years. The appellate court found that the district court failed to adequately test HHS’s assertion that this mandate was impossible. After considering the merits of a group of hospitals Read more →

On August 14, 2017, CMS announced a significant change in its claims audit strategy for Medicare Administrative Contractors (MACs).  Under the new strategy — called Targeted Probe and Educate — MACs “will select claims for items/services that pose the greatest financial risk to the Medicare trust fund and/or those that have a high national error rate.”  Read more →