Medicare Matters

Our team of Medicare attorneys is dedicated to helping providers, suppliers, organizations, and owners with Medicare matters, including enrollment, reimbursement, audits, and fraud and abuse matters.

Medicare Enrollment Matters

Our Medicare attorneys assist providers, suppliers, and organizations with Medicare enrollment matters related to:

Reimbursement Matters

Claims denials and overpayment recovery can cost providers and suppliers hundreds of thousands of dollars. Even more frustrating, the appeals process is difficult to navigate with its strict filing and evidentiary deadlines and multiple appellate stages. Our attorneys help providers and suppliers appeal overpayment demands and defend claims so that may be paid the amount rightfully owed for the services and items provided.

  • Overpayment recovery;
  • Denial and partial payment of claims;
  • Non-participating provider and supplier claims;
  • Provider appeals;
  • Part C appeals;
  • Part D appeals;
  • Secondary payer claims;
  • Coverage determination appeals;
  • Payment suspension; etc.

Medicare Audits

Our attorneys assist providers, organizations, and suppliers during Medicare audits to help prevent overpayment recovery, noncompliance action, revocation, claims denials, fraud and abuse allegations, etc.

Fraud, Waste, and Abuse

It is no secret that the Government is heavily pursuing fraud, waste, and abuse. This has resulted in a dramatic increase in fraud investigations. Our Medicare attorneys defend providers, organizations, and suppliers accused of committing Medicare fraud, waste, or abuse.

  • Medicare fraud;
  • False claims;
  • Kickback;
  • Stark;
  • Submitting claims for medically unnecessary services (abuse);
  • Providing services below professionally recognized standards (abuse);
  • Charging Medicare or beneficiary a higher amount than Medicare fee schedule (abuse);
  • Claims paid with documentation and administrative errors (waste);
  • Overutilization of services (waste); etc.

Other Medicare and CMS Matters

Our Medicare attorneys represent providers, organizations, and suppliers with other Medicare and CMS issues related to:

  • Meaningful Use Audits;
  • Ongoing compliance;
  • CLIA Certification;
  • Managed Care Organizations (MCO);
  • Accountable Care Organizations (ACO);
  • Telehealth; and
  • EMTALA.

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