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Featured / 5.12.2024

What to Expect From Your Medicare or Medicaid Audit

Know Your Rights If You Are Audited by the CMS

If you accept patients through Medicare or Medicaid, you may find yourself or your practice the subject of an audit. The Centers for Medicare and Medicaid Services conducts audits on providers to ensure regulatory compliance. If you are facing a Medicare or Medicaid audit, it is important to work with an experienced attorney who can help guide you through the process.

At The Callahan Law Firm, our legal team has extensive experience working with providers to protect their practice. We know the challenges that many providers face when they are notified of a pending audit. We are here to help. Contact our office at (312) 209-9394 to schedule a free, no-obligation consultation. 

The Healthcare Audit Process

Most healthcare audits are handled through the Centers for Medicare and Medicaid Services. There are several types of audits that you should be prepared to encounter. It is important to contact an attorney as soon as you receive notice in order to ensure the best possible outcome in your case. 

Audits may be used for a number of reasons, including ensuring that payments are made for services that were actually provided, properly documented, and accurately billed. They may also help ensure that providers are not up-coding or failing to comply with any regulations.

Selection for Audit

Providers may be chosen at random for an audit or because of abnormalities that may have triggered red flags in the system. The best way to reduce your chances of an audit is by complying with all state and federal regulations. Things like irregular billing or coding can easily flag your practice for a potential audit. 

Be sure to keep thorough records and properly document anything that may seem out of the ordinary. If you do receive a notification of an audit, you will be prepared to respond with the necessary evidence. 

Notification From Medicaid/Medicare Office

One of the first ways you will know that you have been selected for an audit is through a notification from a Medicaid or Medicare office. It is important to verify that the information on the audit is correct and that it was meant for your practice. While Medicare audits and Medicaid audits are similar, they are separate. It is imperative that you understand your rights and provide all requested information.

Information Request From Auditors

During the audit, you may receive a visit from auditors, or you may receive a request for information. You must comply with the information request. Failure to do so can result in additional penalties. 

A lawyer can help you understand how to prepare for a Medicaid audit and the documents needed for a Medicare audit. Evidence that you may need to collect includes your billing records, your standards and procedures, and any internal audit results.

Review and Determination

The next step in a Medicare/Medicaid audit will be the review and determination. You will be provided with a copy of the auditor's findings. If there are accusations of fraud or overbilling, you may be required to reimburse the government. It is important to know that you may have the right to appeal the decision. 

Right to Appeal

If you receive unfavorable findings in a medical bill audit or another healthcare audit, you should speak with an attorney. A medicare appeal lawyer can help you appeal the decision. You may be assigned a Qualified Independent Contractor (QIC) who will review the information. It is important to consult with a Medicaid appeal lawyer immediately after you receive the decision to determine all of your legal options. 

What to Do If You Are Selected for an Audit

If you are selected for an audit, you need to protect yourself and your practice. Make sure that you verify all of the information on the audit and notify the auditor if anything is incorrect. Additionally, you need to comply with any requests. If you receive a notification requesting that you schedule a meeting, you must reply. Prior to responding, it is in your best interest to consult with a healthcare attorney

How a Lawyer Can Help 

A lawyer can help guide you through the Medicare or Medicaid audit process. The legal team at Callahan Law is well-versed in assisting providers through audits and ensuring their rights are protected. They will help you prepare for the audit, file a response, and collect all of the necessary documentation. If you receive negative findings, they can assist in the appeal. 

Callahan Law Firm is Here For You!

Were you selected for a Medicare or Medicaid audit? Contact us to schedule a free consultation. Call (312) 209-9394 to speak directly with a member of our legal team. We will help determine the best course of action based on the individual circumstances of your case. Get the experienced representation you need and deserve. Call now to get started. 

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