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Fraud & Abuse Audits and Investigations

Whether you are proactively auditing your billing practices or have been accused of fraud or abuse, our team will work with you to conduct audits, and provide compliance and disclosure advice to minimize risk.

Our Approach

With increased scrutiny on the health care industry and the frequency with which federal and state agencies pursue fraud and abuse allegations, our team understands the need to have passionate, deeply knowledgeable representation, as early as possible. We represent health care providers and others in the health industry against claims of fraud and abuse and through audits and investigations, and defend them before the Office of the Attorney General and other state and federal agencies and regulatory bodies. Because many on our team have worked in the Attorney General’s office, we understand the strategies that are taken and can work to develop the best approach for your situation. In addition, we also provide counseling on the front-end, helping you develop compliance programs to avoid future issues.

Clients Include

• Physician groups
• Behavioral health providers
• Hospitals and health care systems
• Home health care organizations and systems
• Senior living providers
• Trade associations
• Pharmacies and specialty pharmacies
• Dentists and specialists

Focus

• Medicare and Medicaid reimbursement regulations
• False Claims Act
• Anti-Kickback Statute
• Stark
• Fraud and abuse compliance programs

Notable Experience

• We have represented hundreds of health care providers in conjunction with public and private third-party payer fraud, waste and abuse audits, investigations and enforcement litigation, as well as false claims act cases.<br />
• Challenged a six figure overpayment demand from a health insurer, demonstrating that the extrapolation method used was fundamentally flawed, which resulted in the insurer withdrawing the overpayment demand in its entirety.

Dedicated Attorneys and Professionals

David M. Aafedt P / 612.604.6447 E / daafedt@winthrop.com

Christianna L. Finnern P / 612.604.6435 E / cfinnern@winthrop.com

Elizabeth H. Schmiesing P / 612.604.6528 E / eschmiesing@winthrop.com

Cody M. Zustiak P / 612.604.6627 E / czustiak@winthrop.com