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When a healthcare audit notice arrives—whether from Medicare, Medicaid, a private insurer, or a Pharmacy Benefit Manager (PBM)—the stakes couldn’t be higher. Repayment demands, clawbacks, license jeopardy, and even fraud allegations can follow. You need more than a lawyer; you need a legal partner who understands the audit process inside and out.
With decades of combined healthcare law and enforcement experience, we guide providers through every stage of an audit—reducing risk, protecting revenue, and defending against overreach.
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Former Government Regulators on Your Side – Our team of healthcare defense specialists is spearheaded by former federal and state prosecutors who understand how the government and its contractors use data mining and proprietary algorithms to identify potential Fraud, Waste & Abuse (FWA) for audits and investigation. Because we understand how the government builds cases, we use their playbook to beat them.
Healthcare Specialty Attorneys and Consultants – Health Law Alliance specializes in healthcare law and is dedicated to defending providers and their licenses from overreach. Our founding partner previously served as a top executive for the biggest companies in healthcare, including McKesson, Relay Health, CoverMyMeds, United Health Group, Optum, and United Healthcare. We know the tricks insurance companies use to deny claims, and use that inside information against them.
Proven Track Record – Some clients turn to us when stakes are the highest, when their businesses are threatened, when their license is challenged, and when their options are limited. Our wins against the government and insurance companies can be reviewed HERE. Many more clients, however, turn to us at the first sign of potential trouble, when we can neutralize the problem before it grows. Either way, we have your back from beginning to end.
Frequently Asked Questions About Healthcare Audits
What should I do when I receive an audit notice?
Do not respond without legal review. Contact an attorney immediately to preserve your rights and avoid admissions or documentation errors that can harm your case.
What kinds of audits do you defend against?
We handle Medicare, Medicaid, commercial payer audits, RAC audits, ZPIC audits, UPIC audits, and PBM pharmacy audits.
Can an audit lead to criminal charges?
While most audits are civil, some findings—especially those suggesting fraud—can be referred to law enforcement. Early legal intervention reduces this risk.
Can a Medicare or Medicaid audit affect my medical license?
Yes. Significant overpayment findings or allegations of fraud can lead to license suspension or revocation. Our defense strategy includes protecting both your revenue and your professional credentials.
How can an attorney help reduce or dismiss audit findings?
We challenge the audit’s methodology, dispute unsupported conclusions, and present counter-evidence. In many cases, we have reduced repayment demands by identifying calculation errors, coding misinterpretations, and documentation that supports medical necessity.
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