Built from the Inside.
Applied from the Outside.
Effective Medicare defense requires understanding how enforcement actions are constructed — not just how to respond to them. Michael McGowan's career spans CMS home health and licensing, FBI healthcare fraud consulting, forensic data analytics at OperaCare, and 25+ years of appeal writing across every level of the Medicare appeals process.
A Career Built at the Intersection of Regulation, Data, and Defense
Centers for Medicare & Medicaid Services
Home Health & Licensing Professional
Michael McGowan began his career inside CMS as a home health and licensing professional — working directly within the regulatory framework that governs Medicare-certified providers. That experience gave him something no amount of outside study can replicate: a firsthand understanding of how CMS constructs audit methodologies, how licensing and certification decisions are made, and where the procedural standards that govern enforcement actions are most frequently misapplied.
That insider perspective is the foundation of every defense he builds today.
OperaCare
Data Analytics & Forensic Analysis
At OperaCare, Michael developed and applied advanced data analytics and forensic analysis capabilities to Medicare billing and claims data. This work built the quantitative infrastructure that now underpins his audit defense practice — the ability to examine statistical sampling methodologies at a technical level, identify deviations from CMS statistical standards, and construct a data-driven record that challenges extrapolated overpayment demands with precision.
When auditors extrapolate a $50,000 sample finding into a $4 million demand, the challenge lives in the numbers. Michael's forensic analytics background means he can find it.
Appeal Writing & Regulatory Advocacy
DAB Appeals, ALJ Hearings & Reconsideration
Over 25+ years, Michael has written and argued hundreds of Medicare appeals — from initial redeterminations through Qualified Independent Contractor reconsiderations, ALJ hearings, and Departmental Appeals Board proceedings. His appeal writing is grounded in controlling DAB and federal court precedent, applied systematically to the specific procedural and factual record of each case.
The result: more than 100 DAB victories and over $1 billion in overpayment demands challenged across every Medicare provider type.
Federal Bureau of Investigation
Healthcare Fraud Consulting
Michael has provided consulting support to the FBI on healthcare fraud matters — bringing his Medicare billing, coding, and audit expertise to bear on complex federal investigations. This work required the same forensic precision and regulatory depth that defines his defense practice: the ability to analyze large claims datasets, identify billing anomalies, and translate complex Medicare regulatory standards into clear, actionable findings.
Working on the government's side of healthcare fraud investigations provides a perspective that directly informs how he defends providers against enforcement actions today.
The Background Behind Every Defense
Michael's credentials span regulatory work inside CMS, forensic analytics in the private sector, federal law enforcement consulting, and decades of hands-on appeal writing. That combination — regulatory insider, data analyst, and experienced advocate — is what makes his defense practice distinctive.
- Former CMS home health and licensing professional
- FBI healthcare fraud consulting
- OperaCare data analytics and forensic analysis
- 100+ Departmental Appeals Board victories
- 1,000+ Medicare enforcement cases analyzed
- $100M+ in overpayment demands challenged
- 25+ years across all Medicare provider types
- Trusted expert consultant for healthcare attorneys nationwide
Every Medicare-Certified Provider Type
"Having worked inside CMS — and alongside the FBI — I understand how the government builds these cases.That knowledge is what I use to dismantle them."
— Michael McGowan, Medicare Defense Group
Let's assess
your situation.
Every Medicare enforcement action has a specific factual and procedural record. Contact us for a confidential assessment — we will identify the key defense angles and provide a clear picture of your options.