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Pillar iv · Audits, Appeals & FWA
iv

When your matter turns on healthcare evidence.

Litigation support · expert services · administrative appeals

Defense firms, plaintiff firms, and in-house counsel work with us because we close the gap between legal strategy and healthcare operational reality. We carry PI licensing, fraud-examiner credentials, and direct experience with UPIC, RAC, OIG, and SUR work — the credentials that hold up in deposition. When the matter turns on healthcare evidence, we work it the way it needs to be worked.

Sub-services within this hub
  1. Litigation support & expert consulting — healthcare operational expertise applied from intake through trial.
  2. Medical record analysis & evidence review — sourced, indexed, exhibit-ready.
  3. Damages quantification & exposure modeling — dollars at risk, dollars defensible, dollars owed back.
  4. Witness preparation & exhibit prep — built to hold under cross-examination.
  5. Administrative appeals — ALJ, UPIC, RAC, MAC appeals up through hearing.
  6. PI-licensed investigation — licensed investigators on staff with healthcare context.
  7. Compliance defense & program review — independent reviews and remediation plans.

The engagement

What you receive

What changes when we work the case:

  • Evidence sourced and indexed to hold at trial. Citation-grade record, exhibit-ready, defensible at cross.
  • Damages quantified with statistical rigor. Dollars at risk, dollars defensible, dollars owed-back — documented.
  • Administrative appeals built to survive. Round-one work designed to close the matter, not invite the next round.
  • Self-disclosure analysis with operational consequence. Decision framework supported by both legal and operational depth.
  • Expert preparation that holds under deposition. Domain expertise with the credentials that matter.

Regulatory context

The rules this work is built to.

Enforcement is at record scale: DOJ’s June 2025 National Health Care Fraud Takedown charged 324 defendants in connection with over $14.6 billion in intended loss, FY2024 set a qui tam record with 979 whistleblower suits, and HHS-OIG reported $7.13 billion in expected recoveries. Targeted Probe & Educate runs up to three rounds before referral for 100% prepayment review or extrapolation — and UPIC extrapolation turns claim samples into universe-wide demands.

For 2026 the ALJ amount-in-controversy threshold is $200 and judicial review $1,960 (Federal Register, Dec. 4, 2025). The appeal is winnable — but only with a record built to the contractor’s own criteria, level by level.

Questions

From the case file.

How quickly can you mobilize on an active matter?

Case file open within 48 hours. ALJ deadlines and appeal timelines are time-critical and we treat them that way.

Do you provide expert testimony?

Yes. PI license, Certified Fraud Examiner credentials, direct contractor experience. Expert preparation and on-the-stand work.

Can you work alongside our existing experts?

Yes. We work alongside in-house counsel, outside firms, and other experts. We bring healthcare operational depth that complements the rest of the matter team.

What does this cost?

Scoping memo in low five figures. Full case work scoped to scope. Expert services billed by retainer or matter, depending on the work.

Are you a law firm?

No. Precisian Group provides consulting, compliance, analytics, and investigative services. We are not a law firm and do not provide legal advice. Legal services described refer to litigation support and expert services delivered to attorneys and providers.

Related provider types

Who we do this work for.

When the matter is consequential

We work the case the same way.

30 minutes. No pitch. We open the case file together — and recommend the next step.