Health Care Audit Defense

Fraud and abuse prevention is one of the cornerstones for achieving the billions of dollars in savings that are being sought by the Federal Government to be redeployed to expand the persons for whom health care services are being provided. These developments have resulted in an increased scrutiny of health care provider fraud and abuse compliance, billing practices and an increase in the volume of overpayment demand letters that are received by health care providers from Medicare, Medicaid and private plan payors. The increased pressure has resulted in unknowing, naive practitioners trapped in a web that results in unexpected or excessive liability and damage to their companies and careers.

Johnson Pope’s Health Care Audit Defense Group has extensive experience in the representation of hospitals, physicians, home health agencies, pharmacies and other health care providers in defense of claims for violation of the Stark Law, Anti-Kickback Statute, HIPAA, overpayment or improper payments by Medicare, Medicaid, insurance companies and other third-party payers. We assist providers in a variety of manners, from “full service” handling of all levels of defense of claims and appeals submissions, to assisting with the drafting of templates, position papers or briefs for healthcare providers who want to handle the appeals on their own, to minimizing audit risk by designing and implementing compliance plans and training.

Practice Areas

Recovery Audit Contractors (“RAC”)  |  Zone Program Integrity Contractors (“ZPIC”)  |   Medicaid  |   Medicare fiscal intermediaries  |  Private insurance companies  |  HIPAA