Healthcare Investigation and Audit Defense
Successful defense of healthcare investigations and provider audits often requires building a team, and gathering resources for your specific defense. Whether it is challenging the denial of a claim based on medical necessity, or fighting an extrapolation, expert input is often required to launch a successful defense. Rosenblat Law, a Medicare and Medicaid Audit defense law firm located in Illinois, has the unique ability to put together a team to best challenge a healthcare fraud investigation, defend a recoupment decision, or represent you or your company during a provider audit. This “no ego” approach puts the client first and foremost in all decisions.What We Do
Rosenblat Law, a Chicago healthcare law firm, represents providers in RAC Audits (Recovery Audit Contractors), ZPIC Audits (Zone Program Integrity Contractors), private payor audits (Blue Cross Blue Shield, Aetna, etc.), Medicaid OIG Audits (Illinois Department of Healthcare and Family Services/Office of Inspector General), and MFCU Audits and Investigations (Medicaid Fraud Control Unit).
Your Chicago healthcare attorney defense team will be comprised of the individuals needed to confront your specific challenges and will consist of a former Illinois MFCU attorney and, as needed, we will team up with other lawyers often consisting of former federal prosecutors and billing and compliance experts.
We use our experience, insight, and relationships, with the government to aggressively defend our clients and if necessary negotiate a favorable resolution.
Providers receiving notices of overpayment often attempt to submit redeterminations, reconsiderations, and even an appeal to the Administrative Law Judge, without the advice and assistance of counsel. Although healthcare counsel is not required, objective advocacy often results in more favorable provider rulings.
Rosenblat Law works with its provider clients to provide the representation and services that the healthcare provider wants. Rosenblat Law can provide full representation, or review and advise the physician, dentist, nursing home, or home health agency preparing its own submission. These services can be provided on an hourly rate or as a flat fee service as agreed upon.Type of Audits
There are several types of audits. A RAC Audit, is an audit conducted by a Recovery Audit Contractor, which is a private company acting on behalf of the Center for Medicare and Medicaid Services. RAC’s are paid on a contingent fee basis and are thus incentivized to find and recover alleged overpayments.
ZPIC Audits, Zone Program Integrity Contractors are tasked to identify fraud, and should raise heighten concerns for providers when compared to a RAC Audit.
The Medicare Appeals process has five levels of appeal consisting of the redetermination, the reconsideration, conducted by a Qualified Independent Contractor (QIC), a hearing before an Administrative Law Judge, a hearing before the Medicare Appeals Council, and finally judicial review.Clear Advantage
Rosenblat Law’s experience in criminal and civil healthcare fraud provides its healthcare provider clients with the insight and experience to avoid or mitigate potential criminal exposure when responding to a notice of overpayment or similar audit.
Mike Rosenblat has been practicing healthcare law for over twenty years, since he was an Assistant Attorney General assigned to the Medicare Fraud Control Unit.
Rosenblat Law has law offices located in Northbrook and Chicago Illinois.