Wachler & Associates, P.C.: Successful Results Across A Wide Range of Audits
Our firm has defended thousands of Medicare, Medicaid, and third party payor audits and has developed successful strategies for substantially reducing overpayment demands. Our attorneys are industry leaders and have been highly successful defending Medicare audits on behalf of healthcare entities, providers and suppliers. Our firm prides itself on staying abreast of the newest laws and regulations affecting such audits and has demonstrated an ability to maintain a high rate of success in the Medicare appeals process. This is particularly significant given that the Medicare appeals process has undergone significant changes since 2005. Recent audits are no exception; we have obtained very successful results. For example:
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Our firm currently represents a large health system in Massachusetts in connection with their inpatient admission denials. To date we have received fully favorable decisions for 100 percent of the inpatient ICD appeals.
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Our firm defended a Medicare audit of an Oklahoma oncologist-hematologist requesting that the provider repay almost $600,000. As a result of the reconsideration decision, the overpayment demand was reduced to $87,000. After a successful Administrative Law Judge decision, the overpayment demand was reduced to $337.
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Our firm represented a Michigan home health agency, which had been subject to an audit of its services provided to 14 beneficiaries. In that case, we received 14 fully favorable Administrative Law Judge decisions, reducing the overpayment demand to $0.
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Our firm defended a California home health agency and successfully appealed 100 percent of its claim denials before an Administrative Law Judge.
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Our firm defended a Medicare audit of a California physician group requesting that the provider repay the Medicare program over $2.3 million. Through our communications with contacts at CMS we were able to effectively stop the withhold of monies from current Medicare billings. As a result of our appeal, the overpayment was reduced to approximately $89,000.
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Our firm defended a $4.6 million Medicare audit of a New York hospice provider on medical review and receiving additional documentation requests, which we recovered at approximately 90 percent.
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Our firm defended a Medicare audit of a physician requesting that the provider repay the Medicare program over $2.5 million. As a result of the Administrative Law Judge hearing, the overpayment demand was reduced to $0.
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Our firm represented a provider group faced with a Medicare audit requesting that the group repay the Medicare program over $850,000. Following the Administrative Law Judge hearing, the overpayment demand was reduced to only $68.
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Our firm represented a large health system that was subject to RAC auditing during the RAC demonstration program. Of the appeals we filed on behalf of this organization, our success rate approximated 90 percent.
