Representative Transactions – Billing Audits and Appeals
Representative Transactions – Billing Audits and Appeals
Representative Transactions –Billing Audits and Appeals (Medicare, Tricare, Medicaid and Private Payor)
Represented multiple physicians in Tricare billing audits of the legitimacy of prescriptions of compounded medications. The Audits were resolved in the clients’ favor without any repayment of monies to government.
Represented physician in successful redetermination appeal of overpayment demand of ZPIC Audit asserting a lack of medical necessity.
Successfully appealed Medicare overpayment demand for a physician group with approximately $24 million in potential exposure.
Obtained favorable appeal decision for behavioral health provider where ERISA Plan was denying payment for medically necessary services.
