Fraud, Waste, and Abuse Investigations

UPIC AUDITS & INVESTIGATIONS

GOVERNMENT-IMPLEMENTED ADMINISTRATIVE ACTIONS

MEDICAL REVIEW

CMS APPEALS & REBUTTALS

RESOURCES & REFERRALS FOR CIVIL & CRIMINAL INVESTIGATIONS

Services Provided

UPIC AUDITS & INVESTIGATIONS

We deliver solutions that prepare, prevent, or guide healthcare providers and provider groups through the process of a UPIC Audit or Investigation. This includes preventative data analytics, medical review, practice management, and unmatched industry knowledge should a healthcare provider or practice be a target of a UPIC action.

GOVERNMENT IMPLEMENTED ADMINISTRATIVE ACTIONS

Administrative actions used against a healthcare provider to recover money paid or prevent money from being paid by the government for services rendered. We provide consulting strategies to prevent administrative and/or legal actions from being imposed.

MEDICAL REVIEW

We assist in conducting an internal audit, including medical review of claims to determine the best strategy for preventing administrative actions and how to respond when actions are taken against a healthcare provider.

CMS APPEALS & REBUTTALS

We assist in drafting appeals and rebuttals to CMS implemented payment suspensions, revocations, pre-payment reviews, overpayments, or other actions that may be taken against a provider or healthcare practice.

REFERRALS & RESOURCES IN CIVIL & CRIMINAL INVESTIGATIONS

Our experts provide resources and referral services during the criminal and/or civil investigation processes.

OPTIMAL PROTECTION AND GUIDANCE

The Justice Group Consulting has over 100 years of combined experience investigating, protecting, and guiding medical practices to ensure their billing procedures are optimally performing. Interruptions in processing claims or payments can be devastating to a practice. We are well versed in claims, appeals, and rebuttals and can thoroughly investigate billing procedures to develop and implement corrective plans.

Tom Larned and The Justice Group have batted a thousand. Every one of their recommendations has been absolutely right on. Tom is an experienced problem-solver with exceptional insight regarding the challenges facing law enforcement organizations today. I have relied on Tom's assessments and mentorship in making positive change to our organization allowing us to build trust and better serve the community.

The Justice Group has helped cities to improve public trust and safety by objectively gathering facts and making sound recommendations regarding police reform.

The Justice Group plays a central role in our payment integrity operations. Over the past 3 years, they have been very proactive in working with our compliance officer and the operations teams to ensure that we proactively evaluated and analyzed any Medicaid payment issues. Not only are they highly skilled in their administrative and investigative approaches, but they are also respected by the team and our state regulators.

The Justice Group has delivered expert knowledge in the prevention, detection, and resolution of potential fraud, waste, and abuse in our healthcare program. Everyone with The Justice Group is extremely professional and with the help of their expertise we have been able to stand up and run a successful SIU program.