Healthcare Audit Defense & Medical License Protection Attorney

Comprehensive Healthcare Audit & License Defense Services

Our healthcare audit defense attorneys represent providers facing all types of audits, investigations, and administrative proceedings:

Medicare & Medicaid Audit Defense

When Medicare contractors audit your practice, immediate action is critical to protect your billing privileges and prevent overpayment demands.

• RAC Audits: Recovery Audit Contractors like Cotiviti and Performant audit claims on a post-payment basis using statistical sampling and medical chart reviews
• UPIC Audits: Unified Program Integrity Contractor investigations by Qlarant, Noridian, and other UPICs look for high-risk billing patterns
• CMS Audits: Centers for Medicare & Medicaid Services compliance reviews and corrective action plans
• Medicare Audit Defense: Comprehensive defense against improper billing allegations and overpayment demands
• Medicaid Audit Defense: State and federal Medicaid audit defense, including dental fraud investigations and managed care audits by the Texas Attorney General’s Office Civil Medicaid Fraud Division
• TRICARE Audits: Military healthcare program audit defense for providers serving veterans and active-duty personnel
• Medicare Recoupment: Defending against overpayment recovery demands and recoupment actions
• Medicare Payment Suspension: Emergency relief from payment holds during investigations into questionable billing patterns or fraud

Medical License & Professional License Defense

Protecting your professional license is our top priority when state boards investigate complaints or regulatory violations.

• Texas Medical Board (TMB) Defense: Physician license protection during TMB investigations, complaint responses, and board hearings
• Texas Board of Nursing Defense: Nursing license protection and defense against BON investigations
• Physician Assistant License Defense: Texas PA board investigation defense and compliance counseling
• Professional License Defense: License protection for all healthcare professionals including pharmacists, dentists, occupational and physical therapists, and licensed clinical social workers and psychologists
• Medical Board Complaint Response: Strategic response to patient complaints and hospital peer review actions
• License Suspension & Revocation Appeals: Emergency relief and appellate representation for suspended or revoked licenses

Medicare Enrollment & Billing Privileges

Loss of Medicare billing privileges can devastate your practice. We help providers maintain and restore their enrollment status.

• Medicare Enrollment Denial Appeals: Appealing CMS enrollment denials and revalidation issues
• Medicare Billing Privilege Revocations & Appeals: Restoring your right to bill Medicare after revocation
• Medicare Exclusions: Preventing OIG exclusions and defending against List of Excluded Individuals and Entities (LEIE) placement
• Medicare Exclusion Reinstatement: Applying for reinstatement after exclusion period ends
• Provider Enrollment Issues: PECOS enrollment problems, revalidation disputes, and enrollment moratoria

Federal Healthcare Investigations

When federal agencies initiate investigations, experienced counsel is essential to navigate complex administrative processes.

• OIG Investigations: Office of Inspector General investigation defense and strategic response
• Civil Investigative Demands (CIDs): Federal subpoena response and document production strategy
• HHS-OIG Self-Disclosure: Voluntary disclosure protocol submissions to mitigate penalties
• Qui-tam Lawsuits: Comprehensive defense when a whistleblower lawsuit leads to a civil investigation
• Medicare 60-Day Rule and Good-Faith Investigations: Guidance through 60-day rule compliance and internal audits into suspected overpayments

Private Insurance & SIU Investigations

Commercial insurance companies conduct aggressive investigations that can threaten your provider contracts and reputation.

• SIU Investigations: Special Investigation Unit defense for private insurance fraud allegations
• Commercial Insurance Audits: Private payor audit defense and documentation review
• Insurance Fraud Allegations: Defending against allegations of fraudulent billing or unnecessary services
• Private Payor Recoupment: Overpayment disputes with commercial insurance companies
• Record Requests: Strategic response to insurance company document demands and information requests

What Should I Do If There Is an Insurance SIU Investigation?

If you receive a request for medical records, notice of pre-payment review, or notice of an SIU audit from a private health insurance company:

1. Do not provide statements or sign non-disclosure or confidentiality agreements without legal counsel 
2. Preserve all documentation related to the investigation
3. Contact an attorney immediately: SIU investigations move quickly and statutes of limitation can diminish your rights and options
4. Do not alter or destroy any records or billing documentation
5. Delegate communications with the insurance company to your legal counsel

SIU investigations can escalate to repayment demands, recoupment procedures, fraud allegations, and other corrective actions. Early legal intervention is critical to protect your interests and resolve matters favorably.

State Healthcare Regulatory Defense

State agencies conduct investigations that can result in license sanctions, exclusions, and civil penalties.

• Texas Health and Human Services Defense: Texas HHS investigation defense and regulatory compliance counseling
• MCO Fraud Investigations: Managed Care Organization audit defense for Medicaid providers
• Texas Attorney General’s Office Civil Medicaid Fraud Division: Defense against state Medicaid fraud investigations and prosecutions
• State Licensing Board Defense: Representation before pharmacy boards, dental boards, and other professional licensing agencies

Who We Represent in Healthcare Audit & License Matters

Our healthcare audit defense attorneys represent medical professionals and healthcare entities facing administrative actions:

Healthcare Professionals:

• Individual physicians and specialists
• Nurse practitioners and physician assistants
• Dentists and dental practices
• Pharmacies and pharmacists
• Physical therapists and occupational therapists
• Chiropractors and podiatrists
• Licensed clinical social workers (LCSW), psychologists, licensed professional counselors (LPC), and licensed marriage and family therapists (LMFT) 

Healthcare Businesses:

• Durable medical equipment (DME) suppliers
• Physician practices
• Med spas and IV hydration clinics
• Home health agencies
• Long-term care facilities
• Diagnostic testing laboratories
• Ambulatory surgery centers (ASC)
• Free-standing emergency departments (FSED)
• Hospitals and health systems
• Medical billing companies

Why Choose Our Healthcare Audit Defense Lawyers

Proven Medicare Audit Defense Experience

Since 1987, our attorneys have represented thousands of healthcare providers in complex Medicare audits, RAC audits, and administrative proceedings at both the state and federal levels. We have successfully:

• Represented hundreds of healthcare practices through the rebuttal and appeals process in MAC or RAC overpayment and recoupment demands 
• Challenged statistical sampling errors, misinterpretations of coverage policy, and demonstrated medical necessity in multi-million-dollar Medicare overpayment demands 
• Prevented Medicare exclusions and restored billing privileges for numerous providers
• Defended Texas Medical Board investigations resulting in dismissals or minimal sanctions
• Resolved UPIC investigations without referral to OIG or DOJ

Administrative Law Focus

Unlike criminal defense firms, we focus exclusively on administrative proceedings, audits, and civil matters. We understand:

• Medicare five-level appeals process
• Administrative law judge (ALJ) hearings
• State medical board procedures
• CMS regulations and coverage policies
• Documentation requirements and medical necessity standards

Texas Medical Board Experience

Our attorneys have extensive experience with Texas Medical Board investigations and have successfully defended physicians against:

• Standard of care violations
• Unprofessional conduct allegations
• Nontherapeutic prescribing claims
• Failure to maintain adequate medical records
• Violations of TMB rules
• Peer review actions

Contact Our Healthcare Audit & License Defense Attorneys

Audit or Professional License Issue? Act Immediately.

Healthcare audits and license investigations move quickly. The sooner we intervene, the better we can protect your practice, billing privileges, and professional license.

Our audit defense attorneys usually respond within 24 hours to schedule an initial consultation to assess your situation and decide on next steps. We handle audit appeals, license defense matters, and administrative proceedings throughout Texas and nationwide for federal and Medicare matters.

Call (713) 783-3110 now or contact us online for immediate assistance.

If your audit has been referred for fraud investigation, see our Civil Healthcare Fraud Defense services.