Every year, thousands of healthcare providers are audited by the government’s Medicaid insurance program. More are audited by Medicare and private insurance. While the prospect of going through this seems frightening with grave consequences, having an experienced healthcare audit lawyer on your side can help you and your practice come out to continue providing medical services.
What to Expect During a Medicaid Audit
Somethings are less frightening when you know what to expect. Such is the case with a Medicaid audit. When it is suspected that your practice is improperly or fraudulently billing Medicaid, they will request documentation that supports the billing code that was submitted.
An issue with your billing was flagged as a potentially fraudulent action. This could be an individual case or a pattern of coding from your practice. Nevertheless, not all audit flags occur because of suspected fraud.
Generally, the auditor will begin the audit by requesting copies of specific documents and records. Once received, the auditor begins reviewing them and decide whether it is necessary to continue the investigation.
One of two things will happen when the investigation is completed. Receiving a clearance letter means that no fraud or inaccurate billing occurred and the auditor is satisfied with the findings. If the opposite is found you could be subject to fines, lose your ability to bill Medicaid, be required to repay the overbilled amount or face jail time.
Getting help from a qualified Medicaid audit lawyer could ensure you come through the audit unscathed.
Why are Doctors Audited?
As a growing problem in the U.S., Medicaid fraud adds billions of dollars each year to state medical expenditures. Certain billing practices that are not always an act of fraud, but could be an indication that fraud is occurring. Therefore, if your practice raises one of these red flags, you will be tagged for an audit.
It even happens to responsible and honest medical practices where rules are broken in small ways. In this way, an audit might be good to expose these small issues before they linger and lead to huge consequences.
What to Do When Facing a Medicaid Audit
The first thing you should do after receiving a letter from Medicaid about a pending audit is contact a Dallas Medicaid healthcare audit lawyer. This letter will explain why you are being audited, which gives you an idea of the scope of the audit.
Keep copies of all communications that you have regarding the audit. Your lawyer can advise if sending more than the audit request to support your coding decisions will help or hurt your case.
Make sure all paperwork is up-to-date before the date of the audit. However, never make changes to existing records. While you might want to do so to explain your decision-making process, making changes to a medical record could make you look guilty.
Ways to Avoid Audits
Even if the audit does not lead to fines and sanctions, this is a time-consuming process that quickly becomes expensive and stressful. After going through one, you will want to avoid dealing with another one in the future.
Your lawyer can help you come through the audit without receiving sanctions; they can also help you avoid going through another one. Reviewing your coding practices can reveal what caused the initial audit. This way, you can make changes without raising suspicions.
In addition, you may need to modify charting and coding so you stay compliant. Incomplete documentation and illegible charting are not best practices. Your lawyer will advise you about this and other issues that can lead to legal problems. This gives you a chance to make meaningful changes.
How a Dallas Medicaid Healthcare Audit Lawyer Can Help
Hiring a lawyer from Raiser & Kenniff, PC gives you an advantage to complete the audit successfully. We find the best coding consultants and other experts who will support your side throughout the auditing process.
When your lawyer hires the consultants, there are legal ways that certain information can be withheld. Having the power to decide what to submit can make a tremendous difference in the outcome.
An experienced Medicaid healthcare audit lawyer knows the tricks and can foresee arguments auditors may use. Call us today to schedule an appointment so we can begin actively planning a defense.