Audits and Special Investigations

Providers routinely face the possibility that payments may be audited or recouped by the government or by private payors.  Athene Law strategically defends audits and special investigations in order to ensure the best outcomes for our clients.

Capabilities

Clients in the healthcare industry, including physicians and groups, facilities, for-profit and non-profit entities, hospitals, and hospital systems need guidance and representation for a variety of needs.

Athene Law’s diverse experience within the healthcare industry has prepared the team to represent practices and professionals in a highly-regulated environment. 

Audits and special investigations capabilities include:

• Responding and complying with subpoenas, investigations, audits
• Appealing and challenging audit determinations
• Negotiating with Special Investigations Unit (SIU) divisions to remove providers from pre-payment review status in connection with billing and coding issues, appropriate documentation, downcoding and upcoding disputes, and more
• Ensuring compliance with fraud and abuse laws, including the 60-Day Rule, the Stark Law, the Anti-Kickback Statute, the False Claims Act, and the California Insurance Frauds Prevention Act