Jan Lambert

Jan has audited dialysis facility charges, dental procedures, evaluation and management (E/M) services (outpatient part A and part B inpatient), anesthesia charges, and all surgical specialty procedures. As part of an IRO team, she has performed yearly compliance reviews for healthcare facilities that are under a Corporate Integrity Agreement (CIA). She has helped develop E/M auditing tools based on Medicare’s regulations for use with all types of E/M services.

Jan’s professional experience includes:

Due Diligence

• Dermatology Specialists
• Anesthesia Specialists
• Ophthalmology Specialists
• Orthopedic Specialists
• Lab Facilities
• Dental Specialties
• GI With and Without Infusion in Office
• Infusion Services-Freestanding and Home
• Dialysis Clinics
• Primary Care/Internal Medicine
• Primary Care-Concierge Service
• Pediatric Clinic
• Urgent Care
• ABA Therapy
• ASC-All Specialties
• OB-GYN Specialties
• Revenue Billing Companies

Compliance Review – Proactive

• Performed quarterly audits on a large hospitalist group with education on post audit results. Services performed inpatient, outpatient, SNF, and home services. Performed audits for a large dialysis facility while under a CIA. Performed post-acquisition audits for different specialties.
• Performed audits for E/M coding for large hospital-based physicians with post-audit training. Performed audits for oncology services at provider-based clinics. Performed audits for radiation oncology services, both facility and professional documentation.
• Performed audits for dental practices for appropriate documentation and medical necessity of procedures. Performed multiple reviews at large university centers with residency programs. Reviewed and audited contracted hospital house physicians (OB-GYN) for appropriate coding. Performed on-site reviews of methadone clinics in the Maryland area and four facilities in different areas of California.

Compliance Review – Reactive-Government Investigation / Potential Qui Tam / Voluntary Pay Backs

• Presented to ALJ hearing for a primary care practice.
• Audited records for a Medicaid investigation of potential over-coding of pediatric dental services, excessive restorations and extractions. She has audited records for a Department of Justice (DOJ) investigation of a large hospitalist group with overbilling of inpatient hospital stays.
• Audited records for a DOJ investigation of excessive dental services for a multiple-group dental practice.
• IRO Engagements.
• As the lead auditor on an IRO team, Jan reviewed records for a multispecialty physician group providing services in a skilled nursing facility – year 1-5.
• As the lead auditor on an IRO team, she reviewed dental records for compliance – year 1-2.
• As the lead auditor on an IRO team, Jan reviewed durable medical equipment products for appropriate orders and medical necessity – year 1-2.
• As the lead auditor on an IRO team, she reviewed the medical necessity of motorized wheelchairs – year 1-3.

Healthcare Presentations/Education

• Presented at the local AAPC chapter on OB-GYN coding rules and coding for radiation oncology procedures, professional and technical.
• Created and presented to UCSF dental providers on compliance and coding for California Medi-Cal.

Work History

• 2018-2025 – Ankura-Healthcare Compliance Auditor
• 2003-2018 – Navigant Consulting-Healthcare Compliance Auditor
• 2000-2003 – Dr. Amer Al-Juburi, Urologist-Auditor
• 1998-2003 – Dr. Christopher Walsh, Radiation Oncologist-Auditor
• 1990-1998 – Dr. William Garcia, Infertility-Auditor
• 1987-1998 – Stokes and Jones, OB-GYN-Practice Manager