Who is to say what is medically necessary? Medical necessity should be determined by a medical provider. Who is to say what procedures and supplies are truly experimental or investigational? There is evidence-based use of a procedure, and there is FDA clearance of supplies and devices.
We represent the interests of medical providers in a world of managed care.
HEALTH CARE FRAUD & ABUSE
What is “fraud and abuse?” “Abuse” has no legal or medical meaning at all. It is a term invented by health insurers to mean that a provider billed for a procedure or supply that the health insurer does not want to pay.
Repayment Demands, Recoupments & Offsets
We understand the insurers’ business model – and it isn’t doctor-friendly. Doctors often don’t know if they are subject to recoupments or are under-reimbursed. We will do an audit of their billing records to determine if they have been injured by insurance company practices. If they have been, we quantify the damages, review the details of their insurance plan and then pursue legal remedies.