Expert Witness and Litigation Consulting
Amenity and its CEO currently and have historically provided extensive support to Healthcare Fraud and False Claims Act investigations resulting from federal and state teams to include investigations resulting from Health Care Fraud Prevention and Enforcement Action Team (HEAT) efforts. Our staff have acted in the capacity of Litigative Consultant and Opinion Witness to law enforcement including the Department of Justice (DOJ) in Washington, DC and nineteen (19) US Attorney/Office of Inspector General – U.S. Department of Health and Human Services (OIG-HHS) Offices in sixteen (16) states. Amenity has been requested to provide subject matter expertise to Qui Tam attorneys in cases where the government has intervened and civil cases where they have not. Our subject matter experts have an established reputation in the areas of Medical Coding and Billing, Health Information Management, Utilization Review, Medical Necessity and Medical Review activities. Our credentials include Certified Coders, Fraud Investigators, Registered Nurses and Specialty Physicians.
At the state level, Amenity works/has worked with Medicaid Fraud Control Units (MFCU) and related departments in conjunction with active law enforcement investigations. We are well versed in Medicaid payment methodologies and program integrity enforcement based on state policies.
Amenity and its staff have worked along the full spectrum of litigation including Investigation, Documentation Review, Data Analysis, Opinion Reports, Hearings, Depositions, Settlement Conferences and Criminal Trial.
Our case participation demonstrates a wide breadth of expertise including, but not limited to:
- Evaluation and Management Upcoding
- Procedural Upcoding
- Overutilization of Modifiers (e.g. 25)
- Facility DRG Upcoding
- Clinical Trials
- Medical Malpractice
- Data Analysis of Billing and Practice Patterns
- Transportation
- Billing for Services Not Rendered
- Falsification of Documentation
We have worked alongside the country’s finest program integrity efforts including Zone Program Integrity Contractors (ZPIC), Program Safeguard Contractors (PSC) and Medicaid Integrity Contractors (MIC). We are committed to supporting protection of the Trust Fund by lending our expertise to the efforts against leakage from waste/abuse and healthcare fraud.