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Overpayment Proceedings (Medicare, Medi-Cal, Denti-Cal, Private Insurance) in California

Representing A Physician

Background: Medicare sought over $270,000 in reimbursement from a physician for physician assistant billing, diagnostic billing and other extrapolated services.
Resolution: After an administrative hearing before the Centers for Medicare and Medicaid Services, our client's overpayment amount was reduced to less than $35,000. (2005)

Background: Private insurance company alleged "fraud" and sought reimbursement from a psychiatrist whose office billed for "missed appointments" which is not allowed by third party insurance. 
Resolution: After extensive preparation and submission, the matter was settled which included no referrals to the Board and no referrals for criminal prosecution. (2016)

Representing An Independent Diagnostic Testing Facility

Background: Medicare sought over $200,000 in reimbursement from an independent diagnostic testing facility for services that were allegedly medically unnecessary.
Resolution: We submitted extensive declarations, medical records, and expert testimony. After the initial conference, the Centers for Medicare and Medicaid Services reduced our client's overpayment amount to less than $30,000. (2005)

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