Successful Defense of Various Clients in Extrapolated Overpayment Audit Appeals

We successfully defended a number of clients across industry sectors, including hospitals, physician practices, hospices, home health agencies and DMEPOS suppliers, in appealing audit results where statistical sampling was used to calculate to extrapolated overpayment demands. Through the Medicare claims appeal process, we have successfully argued that the statistical sampling methodology was invalid and should be set aside and have succeeded in obtaining favorable claims decisions on individual claims. Representative matters include:

  • We successfully defended a home health agency in appealing a $9.3 million extrapolated overpayment resulting from a ZPIC audit. Through the Medicare claims appeal process, we successfully argued that the statistical sampling methodology was invalid and should be set aside, resulting in the demand being reduced to under $175,000 before individual claims arguments were considered.
  • We are currently representing a home health agency in appealing an $18 million extrapolated overpayment demand resulting from a ZPIC audit. At the first appeal level, we were successful in reducing the overpayment demand to $8 million and are continuing to appeal the remaining claims denials.
  • We are currently representing a large, privately held hospice provider in the appeal of 12 ZPIC audits involving extrapolated overpayment demands totaling over $16 million. To date, we have been successful in overturning extrapolation in 7 of the audits at the first level of appeal and have reduced the error rate in all 12 audits, resulting in the overturning of over $9 million in overpayment demands.

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