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Response to audits and litigation

It is an essential part of any proper fraud, waste, and abuse program that a licensed provider have in place a system for auditing marketing, complaints, and ongoing operations. CMS also from time to time will conduct either regularly scheduled audits, or "surprise" audits directed at suspected abuses. Therefore, extensive familiarity with the policies and procedures already in place, the reporting structure, and the key personnel, by outside counsel will facilitate counsel's ability to respond quickly and efficiently to such audits.

The firm's independence as outside counsel is particularly helpful in preserving attorney-client privileged communication. Although theoretically in-house counsel may utilize the protections of the attorney-client privilege, our experience has taught us that regulators take every opportunity to claim that work done by full-time employees of an insurance company is all too often considered non-privileged, and they are much more likely to challenge assertions of privilege by in-house counsel than outside counsel. Since our work will unquestionably be done pursuant to specific consultation or specific retainer agreements for defined legal work, for the purpose of assuring regulatory compliance, we will strive to maximize protections of the attorney-client privilege to protect sensitive client communications and legal advice.

The firm has extensive experience at both the trial and appellate level in litigation of all sorts of civil disputes, including regulatory matters. We can furnish representation in litigation matters before administrative agencies, Federal and State courts, and arbitration proceedings. Since Mr. Lippe is licensed to practice in the District of Columbia, the firm has counsel available to appear in litigation challenging regulatory actions required to be filed in that District.