Representative Transactions – Billing Audits and Appeals

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.