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Health Law Litigation | New York and New Jersey Health Law Litigation Attorney
ARE YOUR MEDICAL CLAIMS BEING AUDITED OR INVESTIGATED?
If you have reason to believe that your medical practice or facility is being audited or investigated by a government or commercial payor, it is imperative that you immediately take all actions necessary to level the auditor or investigator, including an impactful dialogue, forceful negotiations and quite possibly an aggressive appeal. Your approach to the pending audit or review can have a lasting impact on the course of the investigaton and the force with which your practice or facility is pursued. When not properly contained, what once seemed like a routine audit or investigation can lead to a massive civil lawsuit or, in instances of governmental involvement, prosecution by state and/or federal government agencies. If you have reason to believe that your practice or facility is being audited or investigated, please call Ms. Sable, Esq. to evaluate the options available to you and the steps necessary to level and potentially extinguish the audit or review. For more information, please click on the following links.- Commercial Payor Audits, Investigations and Recoupments
- Recovery Audit Contractors - Medicare Audits
CIVIL AND CRIMINAL DEFENSE OF HEALTH CARE MATTERS
Unfortunately, in many instances, what starts as or seems like a "routine" audit, investigation or review - one that is not meticulously "beaten down" by a proactive and aggressive response - can lead to (a) suspension of claim reimbursement, (b) recoupment of previously paid claims, (c) pre-payment medical record review of all submissions and (d) in some cases, civil and/or criminal lawsuit.
Practices and facilities can also be the targets of "automated reviews" - where no medical record is requested from the practice or facility and the reviewer relies on predetermined "data mining" outliers and/or parameters that are programmed for the automated review. If the results of the automated review reveal what the payor believes to be abusive, false or fraudulent claims, the practice or facility will be the target of a full force attack, often leading to civil lawsuits and/or criminal prosecution against the practice or facility.
If you are involved in a civil and/or criminal lawsuit related to your medical practice and/or facility, please call Ms. Sable, Esq. to evaluate the options available. For more information, please click on the following links.
Practices and facilities can also be the targets of "automated reviews" - where no medical record is requested from the practice or facility and the reviewer relies on predetermined "data mining" outliers and/or parameters that are programmed for the automated review. If the results of the automated review reveal what the payor believes to be abusive, false or fraudulent claims, the practice or facility will be the target of a full force attack, often leading to civil lawsuits and/or criminal prosecution against the practice or facility.
If you are involved in a civil and/or criminal lawsuit related to your medical practice and/or facility, please call Ms. Sable, Esq. to evaluate the options available. For more information, please click on the following links.
- Anti Fee-Splitting Statutes
- Anti-Kickback Statutes
- Corporate Practice of Medicine
- False Claims Acts
- Stark Law
Library for Health Law Litigation:
- Long-Term Disability Insurance: Information That Physicians and Doctors Need to Know When Your Claim is Denied
Long-Term Disability Insurance ERISA lawyer discusses what physicians and doctors need to know when their claim is denied. - Factors to Consider When Breaking Up Your New York and New Jersey Health Care Partnership
A professional health care partnership or organization in the process of a breakup or dissolution may need to enter into a health care partnership termination
Frequent Questions for Health Law Litigation:
- What is a Corporate Integrity Agreement?
- What is an OIG advisory opinion?
- What is the Anti-Kickback Statute?
- What are the Stark Laws (the Physician Self-Referral Laws)?
Videos about Health Law Litigation:
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Charles N. Internicola, Esq.
New York, New Jersey
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