Matters
- Collectively reduced or invalidated more than $1 billion dollars of extrapolated overpayment demands against provider from government and commercial payors.
- Successfully consolidated a ten state arbitration with network and out-of-network health care reimbursement claims against a commercial payor, obtain discovery from a third-party vendor on critical evidence regarding use of software tools used to adjudicate claims, and settled for $10 million dollars in eight months.
- Filed the first federal suit in the country challenging an MCO’s use of generative artificial intelligence (gAI) for a postpayment review to determine denials and an extrapolated overpayment as violation of the Federal Medicaid Act.
- Invalidated two extrapolated overpayments in federal litigation against 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 Administrative Procedure Act litigation for failure to preserve and procedure documentation necessary to support an extrapolated overpayment.
- Successfully overturned a CMS payment suspension against a provider with annual Medicare payments in excess of $100 million and prevented the termination of 3,000 employees and loss of services to 25,000 beneficiaries without federal litigation while the provider was under DOJ investigation.
- Overturned all denials used by HHS-OIG to support a $29 million dollar overpayment and 98% error rate against a durable medical equipment supplier in the Medicare appeals process.
- Reduced a DOJ health care fraud loss value of $80 million in a criminal proceeding to $3.3 million at a fatico hearing.
- Represented a national group of oncology specialty practices in coalition litigation against the Department of Veteran Affairs and reduced alleged overpayments by approximately $50 million.
- 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 hospice owned by a health system from a UPIC audit and CMS payment suspension by reducing error rate from 88% to 3%, terminating suspension and had held funds in the amount of $5.5M released.
- Successfully defended a False Claims Act investigation against a revenue cycle management company that had billed for the targets of the Department of Justice litigation with a global loss value in excess of $180 million.
