Welcome to Wachler & Associates' Healthcare Audit Practice
If you or your health care entity has ever been audited based on the findings of a Recovery Audit Contractor (RAC) or other Federal, State or Commercial auditor, you know how important it is to be organized and prepared. You want attorneys on your side with years of experience and a deep understanding of health care reimbursement and the appeals process.
While we can’t stop the Recovery Audit Contractors (RACs) or other auditors from knocking on your door, we can put our years of experience on your side to help you present the best defense possible against their negative findings.
We have been defending health care providers against findings of improper billings by Medicare and other payors for over 25 years. During those 25 years of business, we have successfully defended thousands of audits from Medicare, Medicaid and other third party payors.
Because of our vast experience and inside knowledge of the Medicare appeals process, our attorneys are regularly sought out by provider groups and professional associations to educate health care professionals and others involved in the Medicare appeals process. We regularly provide insight and recommendations at seminars and webinars across the country to educate providers and attorneys on strategies for successfully defending Medicare and other third party payor audits. Some of the venues where we regularly present include prestigious organizations and associations such as the American Bar Association (ABA), the American Hospital Association (AHA), and the American Health Lawyers Association (AHLA) to name a few.
But we do more than just “talk the talk”, we “walk the walk” on a daily basis, defending healthcare providers of all sizes and specialties against overpayment allegations made by RACs and other CMS contractors such as Zone Program Integrity Contractors (ZPICs), Medicare Administrative Contractors (MACs) and Medicaid Integrity Contractors (MICs). Because of the volume of Medicare and other payor appeals that are handled by our attorneys, we are intimately familiar with the regulations, the processes, the potential pitfalls and the best legal defenses and arguments that resonate with the reviewers at all levels of appeal.
Although we devote a substantial portion of our time to defending Medicare and other third party payor audits, we aren’t satisfied with remaining on the defensive. We have also gone on the offensive, in collaboration with various industry groups, to effectuate policy changes at a national level. Notably, our firm has been at the forefront of the policy debate between CMS and hospitals and health systems regarding the payment of outpatient rates when the RACs deny a hospital’s determination of an inpatient admission. We have helped advance the argument that hospitals are entitled to payment of Part B outpatient rates both from a policy perspective through meetings with high level CMS representatives and before Administrative Law Judges (ALJs) and Medicare Appeals Council judges across the country
Through our vast experience, our speaking engagements and our policy work, our attorneys develop many valuable contacts at CMS and among our colleagues. These contacts often prove to be invaluable in many situations. For example, we often encounter situations where contractors do not follow the rules and we must call on individuals at CMS or various contacts who have assisted us in the past.
If you are faced with an audit and would like to explore ways in which we can work together to put our vast experience to work for you, please contact us.
- Office of Civil Rights Announces HIPAA Settlement Stemming from Use of Internet Applications The U.S. Department of Health and Human Services (HHS), Office of Civil Rights (OCR), recently
- U.S. Court of Appeals for the D.C. Circuit Rules on Stark Law Regulations In June, the U.S. Court of Appeals for the District of Columbia Circuit ruled on two regulations
- U.S. Court of Appeals for the Fourth Circuit Upholds $237 Million Judgment Against Toumey Healthcare System On July 2, 2015, the U.S. Court of Appeals for the Fourth Circuit upheld a $237 million verdict
- Proposed Rule Shifts Medicaid Managed Care Enrollment Function to States On June 1, 2015, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule