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When a Medicare audit notice arrives—from CMS, a Recovery Audit Contractor (RAC), Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), or another government entity—the stakes can’t be higher. From repayment demands and license jeopardy to peer reviews and fraud allegations, you need more than legal counsel—you need a dedicated audit defense team.
With extensive experience in both healthcare law enforcement and regulatory defense, we help providers navigate every audit stage—minimizing risks, safeguarding revenue, and warding off overreaching claims.
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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 Medicare Audits
What does a Medicare audit defense attorney do?
We represent providers facing CMS audits, such as RACs, ZPICs, UPICs, or OIG inquiries. We review audit notices, preserve rights, prepare strategic responses, and challenge faulty conclusions.
Why hire an attorney for a Medicare audit?
Audits—though sometimes labeled “routine”—are regulatory proceedings with real-world consequences. We identify flawed calculations, incorrect coding, and incomplete documentation, and protect both your reputation and your license.
Can an audit turn into a criminal investigation?
Yes. Findings suggesting fraud can prompt referrals to law enforcement. Swift, strategic legal action is essential to minimize escalating risks.
Can you help if my license or network participation is jeopardized by a Medicare audit?
Yes. We ensure that Medicare audit sanctions comply with applicable federal and state laws. Medicare auditors are prohibited from acting in bad faith or arbitrarily under applicable law and Medicare audit manuals.
When should I contact an attorney?
Immediately upon receiving any audit notice. Early intervention preserves appeal rights, controls process framing, and protects your reimbursement and license.
How do you charge for your services?
We offer flexible fee arrangements based on the scope of Medicare audit representation required and Medicare audit stage. The earlier we are involved the better, as we can shape and limit Medicare audit scope, making legal representation more effective and less costly. Contact us now to get an exact quote.
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