Brian Michael Oloughlin

An audit finding is only the reviewer’s version of what happened. I build the complete record.

I am an attorney and registered nurse representing providers in Medicare and Medicaid audits, payment suspensions, overpayment demands, and government investigations. I defend providers in commercial payer and SIU investigations, recoupments, and network terminations.

Before law, I investigated Medicare and Medicaid fraud, waste, and abuse for Qlarant, a Unified Program Integrity Contractor. I analyzed claims, records, billing patterns, and provider operations in matters referred to CMS, HHS-OIG, and federal law enforcement. I later served as a New Jersey Deputy Attorney General prosecuting public corruption and white-collar crime.

Earlier, I worked in clinical care and EMS, quality assurance, correctional healthcare, accreditation readiness, EMR implementation, and serious-event review.

An audit begins with a patient, the care delivered, the record created, the code billed, and a reviewer’s interpretation of that sequence. I put those pieces back together.

I examine what the patient needed, what the provider did, what the record supports, and what was billed. Then I test the findings against the statutes, regulations, coverage rules, manuals, contracts, clinical standards, and procedures in effect at the time.

I challenge unsupported assumptions, inconsistent methodologies, defective sampling, misapplied standards, and conclusions the evidence cannot support. I identify weaknesses, measure the exposure, and build alternative positions if the primary argument does not carry.

That is where clinical storytelling and legal advocacy meet. The goal is to keep a documentation dispute from becoming a fraud narrative—and, when exposure exists, limit the damage without surrendering arguments the provider should win.

At Health Law Alliance, I handle:
• Medicare, Medicaid, UPIC, RAC, and other contractor audits
• Commercial payer and SIU investigations
• Medical-necessity, documentation, and overpayment disputes
• Payment suspensions, enrollment actions, and administrative appeals
• Payer and PBM recoupments and network terminations
• Related healthcare fraud and government investigations

I represent physicians, therapy practices, wound-care providers, DMEPOS suppliers, pharmacies, hospices, home health agencies, skilled nursing facilities, and behavioral health providers.

Received an audit notice, payment suspension, repayment demand, or investigative inquiry? Contact me before responding. Send the notice, identify the payer or agency, and tell me the deadline.