Audits & Appeals

We understand how to navigate the administrative appeals and voluntary disclosure processes and provide critical guidance on audits and investigations.


Our Healthcare Reimbursement attorneys handle False Claims Act and commercial insurance disputes in addition to what are now more “routine” government audits, whether by Medicare Administrative Contractors (“MACs”) or more aggressive programs, such as UPICs, SMRCs, TPE, ADRs, MICs, and RACs.  These audits and appeals require an in-depth knowledge of the government’s complex, multi-level appeals process, and an understanding of the healthcare and technical regulatory issues underlying the audits. Although we handle these audits and appeals daily, they are by no means routine for our clients, who may be facing an audit for the first time and may have hundreds of thousands or even millions of dollars at stake.

We handle all aspects of administrative hearings. We challenge statistical sampling and extrapolation by payors, perform medical record reviews, retain experts, and prepare our clients’ witnesses to testify. We also help navigate the government’s various settlement initiatives and fight prepayment audits and exclusions.


  • Successfully represented a Georgia home health provider in a request for reconsideration of a CMS contractor’s decision to terminate the provider’s Medicare enrollment.
  • Represented a national home health provider to appeal over 1,000 claims denied under pre-payment review for medical necessity and successfully overturned many denials at the redetermination and reconsideration stages of appeal.
  • Represented a Georgia skilled nursing facility provider to appeal rehabilitation claims denied for technical issues and successfully overturned 94% of the denials at the redetermination and reconsideration stages of appeal.
  • Represented a national inpatient rehabilitation and long-term care hospital provider in over 200 Administrative Law Judge (ALJ) appeals and successfully overturned many denials through on-the-record decisions and in ALJ hearings.

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