Matters

  • Filed the first federal suit in the country challenging a Managed Care Organization’s use of generative artificial intelligence for a post-payment review to determine denials and an extrapolated overpayment as violation of the Federal Medicaid Act.
  • Invalidated two extrapolated overpayments in federal litigation against the Centers for Medicare & Medicaid Services (CMS) for audit contractors violating a supplier’s due process rights by failing to produce documentation to support extrapolated overpayments.
  • Successfully obtained civil sanctions against CMS in federal litigation for failure to preserve and produce documentation necessary to support an extrapolated overpayment.
  • Overturned all denials used by the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) to support a $29 million overpayment and 98% error rate against a durable medical equipment supplier in the Medicare appeals process.
  • Defended a CMS Medicare and Medicaid fraud, waste, and abuse audit by a Unified Program Integrity Contractor (UPIC) by reducing exposure from $6 million to $155,000.
  • Defended a Medicaid fraud, waste, and abuse audit and reduced exposure from $1.6 million to $300,000.
  • Settled a commercial payor audit of an Autism payor involving a $1.7 million extrapolated overpayment for just over $75,000.
  • Settled a commercial payor audit of a genetic laboratory involving a $1.1 million overpayment for $195,000.
  • Defended a hospice owned by a health system from UPIC audit and CMS payment suspension by reducing error rate from 88% to 3%, terminating suspension and having held funds in the amount of $5.5 million released.