Defense Across Every Front of Medicare Enforcement
Medicare enforcement actions are not routine billing disputes. They are existential threats that require specialized expertise, rapid response, and a proven track record. We provide all three.
Program Terminations
Defending Your Right to Participate in Medicare
A Medicare program termination — or revocation of billing privileges — is one of the most severe actions a provider can face. Once terminated, you cannot bill Medicare, and the financial impact is immediate and potentially permanent.
Important: Termination notices carry strict deadlines — often as short as 15 days. Contact us immediately upon receipt.
What You're Facing
- Revocation of Medicare billing privileges
- Termination of provider agreements
- Exclusion from the Medicare program
- Deactivation of NPI billing numbers
How We Fight Back
- Immediate review of the termination notice and underlying basis
- Filing of timely rebuttal letters and reconsideration requests
- Representation through ALJ hearings and Medicare Appeals Council
- Challenging improper site visit findings and enrollment violations
- Reinstatement strategy and compliance program development
Extrapolated Audits & Overpayments
Challenging the Math Behind Multimillion-Dollar Demands
Medicare auditors use statistical sampling to extrapolate findings from a small claim sample to your entire billing history — turning a handful of denied claims into demands for millions of dollars. These methodologies are frequently flawed and legally challengeable.
Important: Overpayment demands trigger automatic recoupment from future claims if not timely appealed. Act within 30 days.
What You're Facing
- RAC, MAC, ZPIC, and OIG audit findings
- Statistical extrapolation of overpayment amounts
- Demand letters for repayment of alleged overpayments
- Referrals to the Department of Justice or OIG
How We Fight Back
- Expert review of the statistical sampling methodology
- Challenging universe construction, sample selection, and error rates
- Medical record review and clinical documentation support
- Filing redeterminations, reconsiderations, and ALJ appeals
- Negotiating extended repayment plans to protect cash flow
Physician Defense
Protecting Your License, Your Practice, and Your Livelihood
Physicians face unique and compounding risks in Medicare enforcement — from medical necessity denials and documentation audits to exclusion proceedings and referrals to state licensing boards. The stakes extend far beyond a single audit.
Important: Physician exclusion from Medicare can end a career. Early intervention dramatically improves outcomes.
What You're Facing
- Medical necessity denials across entire billing history
- OIG exclusion proceedings and debarment
- Referrals to state medical licensing boards
- False Claims Act exposure and DOJ investigations
How We Fight Back
- Clinical documentation review and gap analysis
- Defense of medical necessity determinations
- Representation in OIG exclusion proceedings
- Coordination with healthcare attorneys on FCA matters
- Compliance program development to prevent future exposure
Attorney Support
Expert Consulting for Healthcare Attorneys
Healthcare attorneys trust Medicare Defense Group as their behind-the-scenes expert when their clients face Medicare enforcement. We provide the technical depth, regulatory expertise, and audit experience that strengthens your legal strategy.
Important: We work seamlessly alongside counsel and maintain strict confidentiality. Referrals and co-engagements welcome.
What You're Facing
- Complex Medicare audit and enforcement matters
- False Claims Act defense requiring Medicare billing expertise
- Provider enrollment and termination litigation
- Expert witness needs for Medicare-related proceedings
How We Fight Back
- Technical review of audit findings and overpayment calculations
- Expert declarations and reports for litigation support
- Deposition preparation on Medicare billing and audit procedures
- Strategic consulting on appeal strategy and settlement valuation
- Ongoing advisory support throughout the matter lifecycle
Facing an audit or termination?
Time is not on your side.
Medicare enforcement deadlines are strict and unforgiving. The sooner you engage an expert, the more options you have. Contact us today for a confidential consultation.