A Track Record Built
Case by Case.

Home Health Agency — Southeast Region

CMS moved to terminate a home health agency's Medicare participation following an unannounced site visit citing alleged condition-of-participation deficiencies. We filed an immediate rebuttal, challenged the surveyor's findings with clinical documentation, and secured a full reversal at the reconsideration level — keeping the agency operational without interruption.

Physician Group Practice — Midwest

A MAC audit extrapolated a $4.2 million overpayment demand from a 100-claim sample. We challenged the statistical methodology, identified flaws in the universe construction, and successfully argued before an ALJ that the extrapolation was invalid. The final overpayment was reduced to $187,000 — a 96% reduction.

Hospice Organization — Mountain West

Following an unsuccessful ALJ hearing, we pursued a Departmental Appeals Board appeal challenging the medical necessity determinations underlying a $1.8 million overpayment demand. The DAB reversed the ALJ decision in full, finding that the clinical documentation supported the hospice elections and that the auditor's methodology was legally deficient.

DME Supplier — Northeast

A durable medical equipment supplier faced revocation of Medicare billing privileges following a failed unannounced site visit. We identified procedural deficiencies in the MAC's process, filed a timely rebuttal with corrective documentation, and secured reinstatement within 45 days — well before the standard timeline.

Independent Physician — Texas

A solo physician faced a $2.1 million overpayment demand and a referral to the OIG following a UPIC audit of evaluation and management billing. We provided a comprehensive clinical documentation defense, challenged the medical necessity denials at every level of appeal, and ultimately eliminated the overpayment demand entirely. The OIG referral was closed without further action.

Healthcare Law Firm — National

A healthcare attorney engaged us as expert consultants in a False Claims Act matter involving alleged Medicare billing fraud by a skilled nursing facility. We provided technical analysis of the billing records, challenged the government's overpayment calculations, and prepared expert declarations that were central to the favorable resolution of the matter.

Ambulance Provider — Southeast

A RAC audit extrapolated an $890,000 overpayment demand against an ambulance provider based on alleged medical necessity deficiencies. We challenged the sample selection, the medical necessity criteria applied, and the extrapolation methodology. After ALJ hearing, the demand was reduced to $41,000 — a 95% reduction.

Skilled Nursing Facility — Mid-Atlantic

A skilled nursing facility received an emergency termination notice with a 23-day effective date following a state survey. We immediately engaged, filed an emergency stay request, and worked with the facility's clinical team to develop a credible plan of correction. The termination was stayed and the facility retained its Medicare certification.