LEGAL SUPPORT

HOW WE HELP:

• Coding, billing, and documentation education

• Assessing the accuracy of coding and payment

• Insurance appeals and disputes

• Negotiating medical bills prior, during or post-treatment

• Understanding and negotiating medical liens

• Assessing the accuracy of Medicare lien letters

• Negotiating with the lienholder

• Understanding insurance coverage and payments

• Contracting with insurance companies

• Evaluation of Florida PIP Payments

• Evaluation of usual and customary charges and reimbursement

• Contract disputes

• Due Diligence for purchases

• Audit Defense

• Investigations

• Data Analytics

• ICD-10 Death Coding and Education

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Samples of cases we have assisted:

• Expert Witness – coded death records to determine incidents of cancer.

  • State of Minnesota, by its Attorney General, Lori Swanson, its Commissioner of Pollution Control, Paul Aasen, and its Commissioner of Natural Resources, Tom Landwehr, v 3M Company Fourth Judicial District Court In and for the State of Minnesota, County of Hennepin.
     

• Document Review – determined practice revenue and proper physician bonus payments

  • Alejandro Tapia, M.D. v The Medical Group of South Florida, Inc., & Abacoa Physical Medicine & Orthopaedics dba Abacoa Physical Medicine. Circuit Court of the Fifteenth Judicial Circuit in and for Palm Beach County, Florida. Roland Collin Bedi v Atlas Towing Service, Inc and John David Poppen. Case Number: 16- 17-CA-009355 in the Circuit Court of the Thirteenth Judicial Circuit of the State of Florida, in and for Hillsborough County, Florida.
     

• Evaluated Medical Bills – determined the Usual and customary charges for like providers in specific geographic areas and fair market value reimbursement for like providers in the same geographic area.

  • Galawezh Showan v Patrick Pressdee and Krispy Kreme Doughnut Corporation. State Court of Gwinnett County, Georgia.
     

• Expert Rebuttal Witness – evaluated past medical bills to determine correct coding and the Usual and customary charges for like providers in specific geographic areas and fair market value reimbursement for like providers in the same geo area. Rebutted defense expert assessment.

  • Andy Dixon and Angela Dixon v. Swift Transportation Company of Arizona, LLC. US District Court, District of Arizona.
     

• Expert Witness – advised the state administrative law judge on Medicare and Kentucky Medicaid regulations regarding appropriate medical coding and payments for inpatient newborn services.

  • Commonwealth of Kentucky Cabinet for Health and Family Services, Division of Administrative Hearings, Health Services Administrative Hearings Branch
     

• Expert Witness – reviewed documents and audited medical records to determine a sample error rate. Determined if cases were appropriately billed at the correct level of care and determined a sample error rate for the statistician to extrapolation to the universe of paid claims and determine damages to the federal government.

  • United States of America ex. rel. Elin Baklid-Kunz, v. Halifax Health. Dis. Court, Middle district of Florida.

  • United States of America ex. rel. Guardiola v. Renown Health, Dist. Court, Nevada.

 

Maybe we can help you. Call us if you have healthcare questions. If we can’t help you, we can point you in the right direction!