There can be no doubt that audits and investigations of healthcare providers are sharply on the rise. Medicare, Medicaid, and commercial insurance carriers are closely scrutinizing medical records and billing data in an attempt to identify possibly fraudulent conduct and recoup overpayments.

Most audits and investigations are not performed at random. Through the use of sophisticated data analysis tools, government agencies and commercial insurance carriers can target providers with remarkable precision.

Audits can be performed on a pre-payment or post-payment basis. Post-payment audits often examine a statistical sample of the provider’s claims, which may result in a large “extrapolated” overpayment. Suffice it to say, audits have the potential to be financially catastrophic for many providers. Fortunately, providers can avail themselves of an appeals process to challenge the audit results and reduce – or eliminate entirely – the overpayment assessment.

About Our Healthcare Audit Defense Attorneys

Our dedicated healthcare attorneys represent providers in audits and investigations initiated by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services, Medicaid Fraud Control Units (MFCUs), Unified Program Integrity Contractors (UPICs), Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), and Special Investigations Units (SIUs) of commercial insurance companies. We have successfully defended countless providers around the country facing pre- and post-payment audits. Our attorneys have the knowledge, experience, and skills to aggressively challenge and appeal audit results and overpayment assessments.

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