Meredith Rarus works alongside healthcare providers, suppliers and payers, as well as law and private equity firms, to provide strategic consulting and litigation support in healthcare matters. She regularly assists clients in assessing the risk of healthcare entities based on her comprehensive knowledge of the claim billing, coding, submission and reimbursement process, as well as applicable industry benchmarks. She performs financial, economic, operational and regulatory analyses to identify potential risk areas of providers under government and commercial audit or investigation. These reviews are within a contemplated transaction and in the capacity as an appointed Independent Review Organization (“IRO”). Ms. Rarus’ work provides her clients with meaningful, accessible and actionable results and recommendations.
Ms. Rarus and her teams have completed large-scale claim reviews advising on the proper coding, billing and documentation for health service organizations based on federal and state guidelines, official Current Procedural Terminology (“CPT”), Healthcare Common Procedure Coding System (“HCPCS”) and International Classification of Diseases (“ICD”) coding guidelines. Ms. Rarus’ experience completing these detailed reviews of medical record and billing documentation assist in determining the completeness and accuracy of the claims submission, documentation, coding, medical necessity and payment of the claims at issue.
In conjunction with transaction due diligence across provider types and settings, Ms. Rarus regularly designs and selects risk-based claim samples for analysis of a target company’s documentation, coding and billing. Her teams have analyzed integration opportunities and risks for existing platforms based on identified operational and documentation findings of add-on targets. She presents findings and recommendations to interested parties, including private equity firms, lenders, underwriters, counsel and key operational personnel. Additionally, Ms. Rarus advises on industry focused risk areas based on the team’s decades of experience with both government and private payers.
Ms. Rarus has performed reviews to assist with investigations alleging fraud, waste and abuse or violation of the Anti-Kickback Statute, Stark Law or False Claims Act. Ms. Rarus and her teams have leveraged large health care data sets to develop flexible and intuitive damage models to determine alleged damages associated with payer and provider disputes and payment based on audit result findings in conjunction with provider self-disclosure protocol. For over a decade, she has prepared expert witnesses to testify in federal and state courts, as well as arbitrations and mediations, based on the facts and opinions outlined in completed reports, visualizations, presentations and demonstratives.