Our firm is an industry-leading law firm in advising and defending healthcare entities that provide services to Medicare patients. Leech Tishman counsels and defends healthcare providers nationwide on the full spectrum of regulatory, reimbursement, and enforcement issues arising from participation in the Medicare program, including enforcement defense, reimbursement disputes, and avoidance and defense of fraud and abuse. As Medicare continues to expand cost-containment initiatives, deploy increasingly sophisticated audit tools, and coordinate enforcement activity with the Department of Justice and state agencies, providers face unprecedented scrutiny of billing practices, medical necessity, documentation, and financial relationships.

Leech Tishman’s Medicare practice is designed to address risk across the entire lifecycle of Medicare participation—from proactive compliance counseling and enrollment strategy to high-stakes administrative disputes, False Claims Act defense, and criminal Medicare fraud matters. Clients rely on us not only to respond to audits and investigations, but to anticipate and mitigate enforcement risk before it arises.

Proactive Medicare Compliance & Regulatory Counseling

Leech Tishman is widely recognized for its front-end Medicare compliance and regulatory advisory work, helping providers operate confidently in one of the most complex regulatory regimes in healthcare. We routinely advise on:

• Medicare participation requirements and program integrity obligations
• Coverage, coding, and medical necessity standards
• Stark Law and Anti-Kickback Statute risk as applied to Medicare reimbursement
• Opinion letters and compliance analyses addressing financial relationships, compensation arrangements, referral structures, and care models
• Medicare billing, documentation, and utilization management practices
• Risk assessment for novel services, delivery models, and emerging technologies

Our attorneys work closely with providers and their clinical, billing, and compliance teams to develop defensible billing and documentation practices that withstand audit and enforcement scrutiny, reducing the likelihood that routine compliance issues escalate into overpayment demands or fraud allegations.

Medicare Enrollment, Participation & Program Integrity

Leech Tishman advises providers throughout the full lifecycle of Medicare enrollment and participation, including:

• Initial Medicare enrollment and revalidation
• Ownership and control disclosures
• Changes of information and reassignments
• Enrollment denials, revocations, suspensions, and terminations
• Appeals of adverse enrollment and participation determinations

We regularly represent providers in disputes involving alleged enrollment deficiencies, affiliation disclosures, and program integrity findings. We understand how enrollment issues can rapidly evolve into payment suspensions, overpayment determinations, or enforcement referrals.

Audits, Overpayments & Administrative Enforcement

Leech Tishman has extensive experience defending providers in Medicare post-payment audits and administrative enforcement proceedings, including matters involving:

• Medicare Administrative Contractors (MACs)
• Recovery Audit Contractors (RACs)
• Unified Program Integrity Contractors (UPICs)
• Supplemental Medical Review Contractors (SMRCs)
• ZPIC and program integrity referrals

Our attorneys handle:

• Medicare Part A and Part B audits
• Prepayment review response
• Medical necessity and documentation reviews
• Statistical sampling and extrapolation disputes
• Overpayment determinations and repayment demands
• Payment suspensions and offsets
• Appeals at all levels of the Medicare administrative process

We are particularly known for challenging flawed audit methodologies, improper extrapolation, and misapplication of coverage standards, often achieving substantial reductions or reversals of overpayment demands before matters escalate further.

Medicare Enforcement, FCA Defense & Parallel Proceedings

When Medicare issues move beyond audits into enforcement territory through OIG, the U.S. Department of Justice or other agencies, Leech Tishman provides experienced, nationally respected defense counsel.

We represent providers in:

• Civil Investigative Demands (CIDs) and subpoenas
• DOJ and OIG investigations tied to Medicare billing and reimbursement
• Federal and state False Claims Act investigations and litigation
• Parallel administrative, civil, and criminal proceedings
• Settlement negotiations, self-disclosures, and resolution strategy

Our integrated Medicare and fraud-and-abuse expertise allows us to advise clients with a clear understanding of how routine reimbursement disputes can be reframed as FCA or criminal exposure—and how to prevent or contain that risk.

Medicare Secondary Payer & Coordination of Benefits

Leech Tishman also advises and defends providers on Medicare Secondary Payer (MSP) issues and coordination-of-benefits disputes, including matters involving:

• Private health plans and MA organizations
• Conditional payment recovery
• Reimbursement demands asserted by commercial payors
• Disputes over primary versus secondary coverage responsibility

Our experience across Medicare compliance, reimbursement, and enforcement allows us to address MSP disputes strategically, accounting for downstream audit, recoupment, and FCA implications.