Healthcare providers facing Medicare overpayment allegations often enter an appeals system that feels fundamentally one-sided. At critical stages—especially early levels and even sometimes at Administrative Law Judge (ALJ) hearings—contractors such as MACs, RACs, or UPICs frequently submit written position papers instead of appearing live. The result? Providers are denied a meaningful opportunity to confront the
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AI, Upcoding, and the Case We Wish Had Been Litigated: Lessons from UCHealth
A recent enforcement action involving UCHealth could have been the case that defined how courts treat artificial intelligence in medical coding. Instead, it became yet another settlement—leaving providers with more questions than answers and regulators with more unchecked leverage.
What Happened?
At the center of the case was the use of AI-assisted coding tools that…
Is WISeR Really Wiser?
If anyone will be at HCCA’s regional conference next week in Alaska, I will be there speaking about e/m changes. Please come say hey if you are there.
My presentation is: “Code Breakers: Navigating Key Changes in CMS Evaluation & Management Services and Coding”
Speaker: Knicole C. Emanuel
Healthcare Compliance: Intermediate
I plan to: 1.…
Knicole Emanuel to Speak at the AHLA Winter Institute 2026
Raleigh partner Knicole Emanuel will speak at the 2026 Winter Institute: Advising Providers & AI in Health Care Conferences, hosted by the American Health Law Association (AHLA), in Las Vegas on February 11-13. Emanuel will co-present a session titled “AI in Health Care: Navigating Legal Risk and Compliance Obligations,” alongside Leslie Boles, co-owner and president…
Medicare Provider Audits: When to Hire a Lawyer and the Challenge of Multiple Alleged Overpayments
Examining the threshold for legal intervention and lessons from the courts
In recent years, Medicare providers across the United States have faced a rising number of audit notices alleging overpayments—sometimes for relatively modest sums such as $25,000, $30,000, or even less. This trend presents a dilemma for providers: the cost of legal representation often exceeds…
Providers Under Siege: The Escalating Burden of Medicare Audits and the Threat of the False Claims Act
Healthcare providers have long navigated the complex world of Medicare audits, working diligently to meet billing standards, document patient care thoroughly, and respond to regulatory oversight. What once existed as a strictly administrative process is now evolving into something far more serious—and punitive. Increasingly, providers are finding themselves at the intersection of standard Medicare audits…
Welcome to the Wonderland of Medicare Audits: AI Takes the Reins!
In the ever-evolving world of Medicare audits, 2025 is shaping up to be a year of Alice’s wonderland. Enter stage right: Artificial Intelligence (AI), a sleek, analytical wonderland where data reigns supreme and human error is no longer allowed to slip through the cracks. If you’ve ever found yourself lost in the tangled forest of…
2025 and AI: The Future of Medicare and Medicaid Provider Audits
The Medicare and Medicaid provider auditing process is about to get its own makeover in 2025. I am talking about artificial intelligence, which will be more accurate than our auditors pre-2025. The Medicare provider auditing process has evolved significantly in recent years, and several key trends are expected to shape the landscape in 2025. These…