Practice/Industry Group Overview
The government and private payers have developed aggressive fraud and abuse programs as a valuable resource for recouping millions of “wasted” dollars within the health care system.
To achieve these ends, the government and private payers have intensified their health care provider audit activity. Although the objectives are laudable, and effective, there is the potential for examiner overreaching in the audit process. Thus, upon careful analysis, the refund amounts sought from hospitals, physicians, pharmacies, home health agencies, and other health care system providers may not be fully owed or justified. These audit pressures also result in increased scrutiny of health care provider billing and record-keeping practices.
Trenam Kemker’s Health Care Audit Defense Team represents hospitals, physicians, home health agencies, pharmacies and other health care providers in their claim prevention activities, and also in defense of claims for overpayment or improper payments by Medicare, Medicaid, and other third-party payors, including:
- Recovery Audit Contractors (“RAC”)
- Zone Program Integrity Contractors (“ZPIC”)
- Medicare fiscal intermediaries
- Private insurance companies
Our attorneys assist clients in developing appropriate strategies to prevent or substantially reduce audit pressures and the resulting overpayment demands.