Hospital/Payer Billing Disputes
Analysis Group has undertaken several cases related to payment disputes involving health care claims. In one such case, we analyzed the financial records of a human service agency accused by a state auditor of overcharging the state. After examining the financial records of the provider and related entities, our consultants revealed that the agency had subsidized rather than overcharged the state.
In a billing dispute between a hospital association and a malpractice insurer, we conducted a complex statistical sampling project involving analysis of a large number of payment records. The case involved the design and implementation of a stratified sampling plan to ascertain the relationship between amounts billed by hospitals and amounts paid by insurance companies.
In another payment dispute, we conducted statistical analyses of medical claims audits submitted to Medicare, Medicaid, and CHAMPUS programs to assess overpayments and calculate potential liability under the False Claims Act. The Court found that our client, the government, was entitled to recoveries in connection with false claims.