When a healthcare provider receives an adverse determination, the appeal is often the last meaningful opportunity to protect reimbursement, preserve participation in government programs, and avoid long-term regulatory consequences.

MDRXLAW represents healthcare providers in administrative appeals involving Medicare, Medicaid, commercial payors, pharmacy benefit managers, licensing agencies, and regulatory authorities nationwide.

Our attorneys have extensive experience challenging:

• Medicare and Medicaid overpayment determinations

• Extrapolation methodologies

• PBM audit findings

• Pharmacy network terminations

• Prepayment review determinations

• Provider enrollment revocations

• Coverage denials

• Administrative sanctions

• Licensing and disciplinary determinations

• Agency hearing decisions

• Judicial review of final administrative decisions where appropriate

We don't simply respond to audit findings—we attack the legal and factual foundation of the decision.