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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.