Healthcare providers whose reimbursement is denied, reduced or questioned by the Medicare/Medicaid programs or commercial payors often seek counsel with the Firm to enforce their rights to obtain proper reimbursement for services they render. These matters often involve challenges to appropriate coding, use of modifiers, medical necessity, site of service and other complex factors involved in payment for healthcare services, making this type of dispute much more nuanced than a typical contract or collections matter.
I have experience at all levels of the Medicare reimbursement overpayment demand process, including redeterminations, reconsiderations, and administrative hearings. In the event of more serious government involvement for False Claims Act, Stark Act and Anti-Kickback Statute violations. I have served as lead counsel in the successful negotiation of settlements that minimize the risk and cost of fines and criminal liability. In this regard, I have worked closely with clients to review billing practices, identify and remedy coding issues, and analyze payor policies and procedures implemented to minimize payment reductions. Under attorney-client privilege, I have worked closely with consulting firms in conducting internal investigations to identify and correct billing inconsistencies and reduce the likelihood of reimbursement denials.