Healthcare providers face increasing scrutiny from private insurance carriers, Medicare, and Medicaid, often in the form of audits, investigations, and reimbursement disputes. These audits can be time-consuming, financially burdensome, and, in some cases, result in recoupments, fines, or allegations of fraud. At Goodman Allen Donnelly, our experienced attorneys provide strategic legal defense for healthcare providers facing third-party payor audits, overpayment demands, and compliance investigations.
Audit Defense & Appeals
Insurance companies and government payors conduct audits to assess billing, coding, medical necessity, and documentation compliance. Our team defends healthcare providers against audits initiated by:
- Private insurers
- Medicare Administrative Contractors (MACs)
- Recovery Audit Contractors (RACs)
- Medicaid Integrity Contractors (MICs)
- Zone Program Integrity Contractors (ZPICs)
- Special Investigative Units (SIUs)
We provide proactive and responsive legal representation, assisting clients through every stage of the audit process, including:
- Pre-audit preparation to assess documentation and compliance risks
- Responding to records requests and audit findings
- Negotiating with auditors and third-party payors to challenge overpayment claims
- Filing appeals and representing providers in administrative hearings
- Defending against fraud, waste, and abuse allegations
Risk Mitigation & Compliance Support
Preventing adverse audit outcomes starts with strong compliance practices. We work with healthcare providers to:
- Develop and implement compliance programs aligned with federal and state regulations
- Conduct internal audits and risk assessments to identify potential vulnerabilities
- Review billing and coding policies to minimize audit risks
- Train staff on proper documentation and reimbursement procedures
Who We Represent
We provide audit defense and compliance counsel to a wide range of healthcare providers, including:
- Hospitals and healthcare systems
- Physician groups and private practices
- Long-term care facilities
- Clinical laboratories and diagnostic testing centers
- Home health agencies and hospice providers
- Med Spas and mobile clinics
- Pharmacies and durable medical equipment (DME) suppliers
At Goodman Allen Donnelly, we understand the impact that audits and reimbursement disputes can have on your practice and financial stability. Our team provides aggressive defense strategies, compliance support, and negotiation expertise to help healthcare providers protect their revenue, minimize liability, and maintain compliance.
If your practice is facing an audit or investigation, contact us today to discuss your legal options.