04/13/2026
A healthcare provider tried to fight over $800,000 in recoupment under a federal payer program without a lawyer. The response cited federal regulations. Confident language. "Mandatory suspension of recoupment." "Binding federal payment obligation."
Unfortunately, however, the cited regulations addressed fair housing and veterans' benefits wage garnishment. Not provider recoupment. Not close.
The result: the auditor ignored it, as though nothing was filed. Offsets ensued. Credibility gone; along with $800,000.
I was brought in later to help. Valid issues may exist, but the matter required a complete reset.
Contrast that with a Medicare recoupment case where on March 25, 2026, an Administrative Law Judge issued a fully favorable decision reversing $913,673 plus interest in a UPIC audit case we have been handling since June 2023.
Redetermination went against us. Reconsideration at the QIC mostly failed. The first ALJ ruled in our favor. The Medicare contractor appealed to OMHA, which remanded to a second ALJ. The second ALJ upheld the decision. Complete reversal. Nearly three years. Four levels of appeal. Every argument built on the statutes, regulations, and authority that actually applied, refined at each stage, aligned with how the Medicare appeals process actually works.
Two cases. Similar stakes. One collapsed because the work product looked right but was not right. The other survived because the arguments were tested, defensible, and durable under scrutiny.
AI can generate what looks like authority. But looking like authority and being authority are not the same thing. Confidence is not competence.
Eric is covering this, along with the ethics rules across three jurisdictions and practical guidance for both lawyers and healthcare professionals, in a webinar on Tuesday.
Register: https://tinyurl.com/4mm9rrb3
