Medicare and Medicaid Audit and Overpayment Appeals Attorney

Are you preparing for an audit or have you recently been audited for your Medicare and Medicaid billing and coding practices? As you have probably noticed there is an enormous push by the government for all Medicare and Medicaid contractors to recoup money for fraud, waste and abuse. Audits by these Medicare and Medicaid contractors are on the rise. These audits are used to target Medicare and Medicaid billing and coding of providers. They are designed to investigate for overpayment of claims or fraud, and often times these government auditors make many mistakes in their own auditing practices. A provider should never accept an “overpayment” or fraud claim at face value. Providers always have the right to question the audit and should definitely seek legal counsel if they have any questions or concerns about an audit.

Eyler Law Offices handles any Medicare and Medicaid or private insurance companies billing, coding, compliance, and fraud issues. We will help you respond to any overpayment, billing and coding, fraud or compliance allegations against you from any Medicare or Medicaid contractor, any state or federal government agency or from any private insurance company.

We will attend all hearings and appearances, ensuring that our clients have the opportunity to be heard and to clear up any allegations made against them. We also undertake negotiations to reduce the amount a client owes in fines or reimbursements for possible over-billing or over-payments. Call Eyler Law Offices at (214) 540-7750, or email us on our contact form to discuss your Medicare or Medicaid appeal case further.

Medicare/Medicaid Contractors – RAC, MAC, ZPIC, MIC

Medical providers/businesses confronting a Medicare or Medicaid audit should immediately seek experienced/qualified legal counsel upon any contact or a request for records from a Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), Zone Program Integrity Contractor (ZPIC), Medicaid Integrity Contractor) MIC, United States Health and Human Office of Inspector General, Health and Human Services Commission of Texas, Program Integrity or any other government agency or contractor. Sometimes it is possible to avoid lengthy legal proceedings by immediately obtaining an experienced/qualified health care lawyer.

There is no doubt that these Medicare/Medicaid contractors will respond and act differently if they have to explain their actions to legal counsel. Too many times, the provider will attempt to explain what they believe the problems is and everything they say is turned against them or taken completely out of context. Furthermore, it is important for providers to know that time is of the essence as some legal rights may be waived if not raised immediately by the provider. Medical providers/businesses need to know that Recovery Audit Contractors (RACs) work on a contingency-fee basis, which means they are completely motivated by their own financial gain when they are auditing and examining Medicare and Medicaid claims filed by hospitals, medical clinics, nursing homes, long-term care providers, hospice, home health agencies, and physical therapy companies. If you are being audited or may soon be audited by a Recovery Audit Contractor or any auditor, just remember that they are generally private companies employed by the government to investigate and review health care providers’ billing and coding errors, any/all accounting mistakes/errors, any inaccuracies, up-coding or un-bundling, and/or fraud. RAC’s review claims on a post-payment basis. Again, remember that RAC’s are paid on a percentage basis for any money they recover for Medicare (government) and are they are very aggressive in their endeavors to recoup the money as the survival of their business depends on recouping money from providers.

These Recovery Audit Contractors (RACs) and various Medicare/Medicaid contractors, attempt to examine all of your provider claims in an attempt to discover any overpayments, anything they decide appears to be incorrect payments, improperly coded payments or any potential fraudulent billing of Medicare or Medicaid. At Eyler Law Offices, we will advise you during the audit process to help preserve your rights and to ensure that the auditor’s comply with the rules/guidelines of their own practice. We will also assist you in how to comply with the auditor’s request/ demands for billing and coding information.

Overpayment Appeal

As you can imagine, losing an overpayment appeal can be devastating to any provider. Many of the overpayment determinations involve such huge and massive amounts of money that a provider will have to analyze whether they can stay in business. At Eyler Law Officers, we understand how devastating it can be to get that “overpayment” letter and we will do everything in our power to help you with the claim.

We understand the importance of questioning and addressing any/all audits of your health care provider business. We have an understanding and familiarity with the audit process which will allow us to help you understand and respond to any dispute or overpayment that you are being accused of.

At some point in time, many health care providers will receive Medicare or Medicaid payments that result from a mistake or billing error. Often times the issue of overpayments merely involves mistakes or errors with the amount paid or the services billed for by the provider. Many times, this mistake or error in billing or coding can be easily resolved by simply paying back the money or making adjustments to your billing/coding.

The real problem arises when the provider is unaware of the overpayment or billing/coding issue and it goes unnoticed for many months or years which result in an enormous “overpayment” claim by the government. This type of “overpayment” claim can often times can cause a provider substantial financial difficulty in paying back the amounts. But more importantly, sometimes it can trigger a fraud investigation by the government or the agents that work for the government.

Appeals Process

Eyler Law Offices assists clients by representing them in the overpayment determinations process. We will help you with the appeals appeal process as far into the process as necessary. We will assist you with gathering and providing the evidence necessary to show your claims were proper. We are highly experienced at dealing with these types of health care administrative matters. No matter what stage, we are ready to step in and begin working immediately. We walk clients through the entire process, from reviewing every piece of claim data to hiring experts to support their case. Eyler Law Offices will fight for you through every step of the process. We know how crucial it is to dispute any and all errors and to prove the validity of claims to avoid even the perception of fraud, waste or abuse.

Assertive Appeals Representation

After an audit, there is a possibility that you may be ordered to repay Medicare or Medicaid claims that have been determined as an inappropriate or illegal claim. At Eyler Law Offices, we willaggressively help guide you through the overpayment appeals process to avoid any wrongful governmental recoupment of monies or any unnecessary expenses as a result of answering an overpayment claim.

Whether you desire to appeal and overpayment claim by the RAC, or you want work out a suitable payment arrangement, we will be by your side working diligently until your overpayment claim has been resolved to appropriately.

We pride ourselves on keeping on top of the very latest and critical information in the every-changing and complex healthcare industry. With the implementation of the American Recovery and Reinvestment Act of 2009 (ARRA), and the Patient Protection and Affordable Care Act (PPACA), businesses are facing a vast amount of new laws that they must be in compliance with or they face possible severe sanctions and/or prosecution. With this in mind, we use all available resources to communicate this information and to promptly and efficiently provide the very best legal representation to our clients, be it in state or federal court, administrative courts or forums, or in appeals.

If you need an attorney in the Dallas / Fort-Worth metroplex, contact the Law Offices of Bridget Eyler Law Offices, at (214) 540-7750 for any matter arising from health care fraud, waste, or abuse charges, or email us from our contact page to discuss your case further.

Contact Us

  1. 1 Free Consultation
  2. 2 Available 24/7
  3. 3 We Will Fight for You!
Fill out the contact form or call us at (214) 540-7750 to schedule your free consultation.
Submitting this form does not create any Attorney-Client Relationship.