Every error we identify is matched to the exact regulation it violates. Your dispute letter cites each one by statute name and section number — the same references hospital compliance departments are legally required to respond to.
Law 01
No Surprises Act
42 U.S.C. § 300gg-111 · Effective Jan 2022
Bans out-of-network balance billing for emergency care and most non-emergency services at in-network facilities. Violations expose hospitals to $100/day per patient in CMS penalties.
Balance billingOut-of-network ERSurprise bills
Law 02
CMS Medicare Fee Schedule
42 CFR Parts 412–415 · Updated annually
The national standard rate for every procedure code. We compare your charges against the published 2026 rate and your hospital's own price transparency data — outlier charges cited with both figures.
Overpriced proceduresFacility feesPOS code errors
Law 03
NCCI Bundling Rules
National Correct Coding Initiative · CMS quarterly
CMS publishes 3.3 million code pairs that cannot be billed separately. Splitting these to inflate your bill is an NCCI violation. We cite the specific edit pair and effective quarter in your letter.
Unbundled proceduresCode pair violationsDuplicate codes
Law 04
ICD-10-CM Guidelines
CMS + AHA · Updated October 1 annually
Wrong diagnosis codes change what your insurance covers. A preventive visit miscoded as diagnostic means your full deductible applies for a visit that should be free. We catch every coverage-affecting miscoding.
Wrong diagnosis codesPreventive vs diagnosticCoverage errors
Law 05
Fair Debt Collection Practices Act
15 U.S.C. § 1692 · FDCPA
Once you send a written dispute, collection activity must legally pause until the debt is verified. Your letter invokes this right explicitly — the hospital cannot send your account to collections while your dispute is under review.
Collection pauseDebt validationCredit protection
Law 06
State Balance Billing Laws
Varies by state · checked against your location
Many states exceed federal protections. California, New York, Texas, and Illinois have stricter billing limits and faster dispute timelines. We route your dispute to the strongest available law — federal or state.
State-specific rightsCharity careStronger limits
Law 07
False Claims Act
31 U.S.C. §§ 3729–3733
Prohibits submitting false or fraudulent claims for payment to government health programs including Medicare and Medicaid. Hospitals face treble damages and penalties of up to $27,894 per false claim. Your letter cites this where billing for services not rendered.
Services not renderedMedicare fraudPhantom charges
Law 08
ACA Section 2713
Preventive Care Mandate · 42 U.S.C. § 300gg-13
Requires insurance plans to cover recommended preventive services at zero cost to the patient. When a preventive visit is miscoded as diagnostic, your insurer charges you a deductible for a service that should be free. We identify and dispute every preventive care miscoding.
Preventive care billingZero-cost servicesACA mandate
Law 09
Medicare Assignment Rules
Social Security Act § 1842
Participating Medicare providers must accept Medicare's approved amount as full payment and cannot balance-bill Medicare patients beyond their standard cost-sharing. We check every Medicare bill for assignment violations and excess charges.
Medicare overchargesAssignment violationsExcess billing
Law 10
Hospital Price Transparency Rule
CMS 2021 · 45 CFR § 180
All hospitals must publicly post their negotiated prices for 300+ standard services. When your billed amount significantly exceeds your hospital's own published rate, we cite the discrepancy with the published figure — a powerful dispute tool.
Price transparencyPublished rate gapsChargemaster abuse