The experienced attorneys at Kennedy Attorneys and Counselors at Law work with doctors, hospitals, diagnostic testing facilities, home health agencies, nursing homes, medical equipment suppliers and other healthcare providers in all matters pertaining to reimbursement and coverage.
Our highly trained attorneys work with clients on the full range of insurance payment and reimbursement issues with both government and private payers. We consider it our business to understand the opportunities and challenges that face the industry and, more importantly, our clients’ businesses. The healthcare reimbursement lawyers at Mark Kennedy Attorneys and Counselors at Law can assist healthcare providers with matters such as:
- Representation at PRRB hearings or other tribunals;
- Challenging allegations of overpayment, audit penalties, and recoupment actions issued by CMS, third-party administrators, insurers, and health plans;
- Contesting denial of coverage, out-of-network designation, or charges outside of “usual, customary, and reasonable;” and
- Representation in disputes concerning agreements or contracts.
Medicare Reimbursement Attorneys
Federal healthcare programs like Medicare and Medicaid pay for more healthcare services than any other single entity. Healthcare providers that bill these programs must successfully navigate their complex and constantly changing red tape. Those that don’t face costly penalties or even revocation of enrollment in the Medicare program and termination of billing privileges.
We have extensive experience with Medicare and Medicaid appeals and audits, including Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs), hospice CAP appeals, and state enforcement agencies, such as the Texas Health and Human Services Office of Inspector General (OIG) and Texas Attorney General’s office.
Government Payor Extrapolation Cases
We have also been successful challenging the government’s use of extrapolation (using a small sample and applying it against a larger universe of claims) to determine over-payments. Our attorneys have particular expertise in the areas of private and public reimbursement, from individual claim negotiation through audit and over-payment litigation.