Expert Witness and Litigation Consulting
Amenity and its CEO currently provide 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 more than twenty (20) US Attorney/Office of Inspector General – U.S. Department of Health and Human Services (OIG-HHS) Offices in seventeen (17) 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. Additionally, Amenity provides these services to healthcare attorneys on behalf of commercial and managed Medicare and Medicaid plans. Our subject matter experts have an established reputation in the areas of Medical Coding, Billing and Data Analysis, Health Information Management, Utilization Review, Medical Necessity and Medical Review activities. Our credentials include Certified Coders, Fraud Investigators and Registered Nurses.
At the state level, Amenity works/has worked with Attorney Generals and 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)
- Itemized Billing
- Facility DRG Upcoding
- Clinical Trials
- Behavioral Health
- Professional Claims
- 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 law enforcement, 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.