© 2019 Bergwall Law Firm, P.C.

165 Passaic Avenue, Suite 304

Fairfield, New Jersey 07004

Tel: 973-276-6100 / Fax: 973-276-6169

Insurance Fraud Defense

Healthcare Investigations and Insurance Fraud Litigation

Healthcare Investigations and Litigation involving Fraud and Reimbursement.​

 

The firm provides a highly qualified team with a long history of success in managing and resolving healthcare-focused audits and investigations. We work on behalf of our medical provider clients who have been targeted for audits, investigations and related regulatory inquiries brought by insurers and state and federal regulators. 

 

Audits and investigations in the healthcare industry often arise from inquiries and allegations associated with:

  • “Up-coding” and/or “over-coding” payor claims.

  • Fraudulent billing.

  • “Kickbacks”.

  • In-network audits.

  • Licensing issues.

  • Medicare and Medicaid investigations.

 

Because both civil and criminal investigations are fact sensitive, outside experts and consultants are retained to calculate figures and related discovery during audits and investigations. Insurance company audits are not uncommonly based on inaccurate data and may be flawed, either by a lack of depth or inaccurate metrics needed to prove claims for refunds of billings.

It is important to retain counsel early on in a healthcare investigation and hire an experienced attorney capable of handling over-reaching subpoenas and inquiries.  The firm's practice is both in State and Federal courts.