“They deliver a top quality product. I can count on what they send me. I don’t have to second guess or worry. The manner in which they deliver it is timely, it’s professional, it’s complete. They anticipate my needs. They are glad to brainstorm. I just can’t say enough.”
— Current state Medicaid client

Expert Witness Litigation Support

Myers and Stauffer has extensive experience in the areas of litigation and compliance auditing through the detection of fraud, waste, abuse and improper payments through claim/billing reviews. In addition, we have represented states before CMS, DOJ, and OIG, as well as provided appeal representation and expert witness testimony. Our services include performing investigations into the areas of:

  • Improper billing of emergency doctors
  • Improper partial hospitalization billings
  • Incorrect site-of-service billings
  • Inpatient psychiatric billings
  • Unbundling
  • Upcoding
  • PATH issues
  • Home health care improprieties
  • Improper cost report filings
  • Nursing home abuse and neglect

PAST AND CURRENT SERVICES

  • Assisted the Department of Justice (DOJ) and U.S. Attorney’s office investigating Medicare program abuses in hospital, skilled nursing facility, home health and other provider settings. The investigations involved allegations of Medicare health care providers filing fraudulent Medicare cost reports.
  • Used audit and other statistical analyses to identify practices of unbundling, up-coding and improper Medicare cost reporting. Each investigation completed resulted in a positive settlement in favor of the government and the recovery of hundreds of millions of dollars.
  • Developed audit techniques and performed focused audits on Medicare skilled nursing facility cost reports of a national nursing home chain. Reviews proved that staff allocations reported to the Medicare program in the provider cost reports were erroneous and/or unsupportable by the provider’s records.
  • Performed field audit of a hospital’s Medicare cost report under investigation for fraudulent filing with the Medicare program. Myers and Stauffer auditors were on-site for several weeks and reviewed documentation related to expenses, charges, statistics, provider-based physicians and home office and related parties.
  • Assisted in the review of reserve cost reports and the underlying documentation of a national hospital chain under investigation for fraudulent Medicare cost report filing. Assisted in the development of a large statistical database to analyze the reserve cost report issues.
  • Reviewed and evaluated cost reports and underlying documentation used by a health care consulting firm under investigation for fraudulent Medicare cost report preparation and re-openings.
  • Assisted State Program Integrity Units, Special Investigation Units, Surveillance and Utilization Review Units, or Medicaid Fraud Control Units in conducting Medicaid data analysis and support for on-going fraud, waste and abuse audits of Medicaid providers.
  • Developed test plans, conducted sampling and performed population estimates of mispayments to support state audit initiatives.
  • Assisted and provided technical support for Inspector General in fraud, waste and abuse audit of large national pharmacy chain.
  • Provided litigation support and expert witness services during civil, criminal, administrative or appellate hearings.

 

Myers and Stauffer partners exclusively with state and federal health agencies, so there is never a conflict of interest.