Service Scope and Legal Disclaimers

1. Scope of Service and Termination of Engagement

Medical Bill Forensics LLC is an independent, forensic medical bill auditing firm and is not a law firm, debt management company, accounting firm, medical provider, medical clearinghouse, or health plan.

The terms “client” and “patient” are on this website and in forensic audit reports; these terms may apply to the same individual but are used differently. Medical Bill Forensics LLC is not a HIPAA covered entity (provider, clearing house, or insurer) and does not have “patients”; Medical Bill Forensics LLC has clients which may be the individual referred to in the provided billing document as the “patient.” Medical Bill Forensics LLC provides independent. third-party forensic analysis of supplied, medical billing documents concerning alleged care the client may have received as a patient of the billing entity identified in the supplied billing documents.

The individual receiving a forensic audit is not an ongoing client of Medical Bill Forensics LLC beyond the delivery of a forensic audit report with associated post-audit conference. The delivery of a forensic audit report and reception, or waiver, of a post-audit conference concludes the professional engagement for the specific billing documents reviewed. A virtual, post-audit findings conference is available to the client, or their legally designated agent, should they wish to schedule such a conference and review forensic audit report findings with Medical Bill Forensics LLC. Unless a client, or their legally designated agent, completes the virtual, post-audit conference within ten (10) business days from the date of report delivery to their designated email address they automatically waive the right to the conference. This means that the client is no longer a client of Medical Bill Forensics LLC regardless of anything past the time of 11:59:59 pm on the tenth (10th) business day past delivery a forensic audit report to their designated email address.

2. Non-affiliate Statement

Medical Bill Forensics LLC is not an affiliate of any healthcare provider, hospital, medical clinic, or private insurer. We do not represent, act on behalf of, or receive compensation from any government institution (state or federal). Medical Bill Forensics LLC does not function as a legal representative, agent, or advocate for the client, and does not engage in mediation, negotiation, or direct communication with hospitals, clinics, or insurance carriers on behalf of the client.

3. Review of “As-Is” Billing Documents

Medical Bill Forensics LLC does not accept records, correspondence, or documentation directly from any hospital, clinic, third-party payer, or other patient-contracted representative; we only accept billing documents for audit directly from a client or their legally designated agent. Medical Bill Forensics LLC will not share or sell any information regarding any client with any third party outside of the client’s legally designated healthcare surrogate or representative.

Medical Bill Forensics LLC makes no claim as to whether the charges are clinically substantiated within the broader patient medical record or internal billing entity record archives for the patient. Itemized medical bill are final documents which issuers hold to be factually accurate as provided; if the billing entity is a covered entity itemized bills are federal documents. As such, the burden of proof regarding clinical substantiation for coding non-conformities within the audited documents rests solely with the billing entity.

4. No Legal Responsibility for Client Use of Report

The client agrees to hold harmless and indemnify Medical Bill Forensics LLC from any and all claims, liabilities, or damages arising from the client’s use or distribution of a forensic audit report, including the distribution of a report to the client’s legal counsel, leally designated agents, healthcare advocates, or third-party negotiators. Any use of an audit as evidence in a formal dispute, appeal, or legal proceeding is conducted at the discretion and direction of the client and between, or on behalf of, the client and a healthcare provider organization, third-party payer, legal counsel, or healthcare advocate.

Trigger of Liability: The act of utilizing a forensice audit report from Medical Bill Forensics LLC— whether for tax record substantiation, achieving a billing reduction, for use in legal proceedings, or for dissemination to third parties (including insurance carriers and healthcare providers) — constitutes a binding agreement by the client to assume all risks associated with such actions. Medical Bill Forensics LLC provides an objective analysis of the billing document’s adherence to federal billing standards; however, the strategic application of audit findings is at the sole discretion and risk of the client.

5. No Tax Advice Provided

Medical Bill Forensics LLC is not a tax advisory firm, CPA, or financial advisor and does not provide tax advice. Forensic audits identify correct coding application and coding discrepancies within the reviewed medical billing documents. Any client of Medical Bill Forensics LLC intending to use a forensic audit report for federal or state tax substantiation purposes should consult a licensed tax attorney or CPA regarding the applicability of their audit report to their specific tax situation. Clients may provide our tax memo (found on our website and emailed) to their tax preparer.

6. Not a HIPAA Covered Entity

Medical Bill Forensics LLC is not a “covered entity” or “business associate” as those terms are defined under HIPAA’s Administrative Simplification and Privacy Rule provisions (45 C.F.R. § 160.103). We are not a health plan, health care clearinghouse, or health care provider, and therefore we do not transmit health information in connection with any HIPAA-covered transaction; no HIPAA-covered transaction arises from our business. Accordingly, HIPAA’s Privacy and Security Rules do not directly apply to the information Medical Bill Forensics LLC receives, reviews, or stores in connection with this report. Medical Bill Forensics LLC maintains its own data security and confidentiality practices, as described in its Privacy Policy, and clients should review that policy to understand how their information is collected, used, and protected.

7. No Medical Practice

Medical Bill Forensics LLC does not practice medicine and does not provide medical advice, clinical diagnoses, or treatment recommendations of any kind. Forensic audit reports produced by Medical Bill Forensics LLC are limited exclusively to the structural and coding accuracy of the billing documents provided by the client or their legally designated agent — it is a regulatory compliance analysis of data elements and code sets within a healthcare transaction, not a clinical evaluation of the care the client received or should receive. No finding in a client forensice audit report should be construed as a medical opinion, a determination of whether care was clinically necessary or appropriate, or advice regarding the client’s medical treatment, condition, or health decisions. Clients with questions about the clinical appropriateness of services they received should consult a licensed physician or healthcare provider.