new york medicaid audits lawyers
New York healthcare providers of any type can be targeted for healthcare audits and associated overpayment demands if they participate in the Medicaid program. The same holds true for participation in the Medicare program as well. This include physician practices, hospitals, urgent care center, and any other type of healthcare provider that provides services and receives reimbursement through the Medicaid program
As a Medicaid-approved healthcare provider, you need to understand your rights and interests should you ever face an audit and a demand for a so-called overpayment. You also must fully appreciate the significant benefits of engaging the services of New York Medicaid audit lawyers in your case.
Wide Targeting Healthcare Providers
There can be no doubt that fraud can be a problem in the Medicaid program. With the state intent of fighting fraud, the Medicaid program is highly aggressive in auditing healthcare providers of all types. The process does identify healthcare providers that engage in improper billing activities. However, because it casts such a large net, the audit campaign also snares honest, reputable individuals and institutions. You may be a completely honest healthcare provider. You may be scrupulous and highly accurate with you billing and record keeping. Nonetheless, despite your best efforts, you find may find yourself neck deep in a Medicaid audit based on a contention of overpayment.
Authority of Medicaid Recovery Auditors
Medicaid recovery auditors are given broad authority by the government in taking on healthcare providers. These recovery auditors oftentimes presume all targets of their audits to be exactly the same. They tend to begin an audit process with convinced that healthcare providers likely are guilty of overbilling and similar types of improper practices. As a healthcare provider, you may perfectly understand that this type of broad categorization of the profession is unfair and inaccurate.
Appealing You Medicaid Healthcare Audit
The process of appealing the decision made in a Medicaid audit is a complicated. The appeals process is multi-level. The fact is that the best course to take to to successfully maneuver through the process is with the assistance of New York Medicaid audit lawyers.
New York Medicaid audit lawyers understand the complex appeals process. They have crafted effective strategies that work to provide a client with the relief sought after a negative determination made during a Medicaid audit.
New York Medicaid audit lawyers provide a wide array of necessary functions. These include everything from coordinating an internal audit, to develop suitable evidence to support what you believe are proper payments made to you, to appearing at various hearings scheduled of the appeals process, on your behalf. New York Medicaid audit lawyers also prepare the documents and other materials necessary to start and pursue your Medicaid audit and overpayment appeal.
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(212) 300-5196Working Around the Medicaid Healthcare Audit appeals Backlog
A truly difficult and frustrating element of a Medicaid audit appeal is the large backlog associated with the process. Unfortunately, your own case can be left to languish for an extended period of time, without any determination.
You need to realize that some New York Medicaid audit lawyers that have significant experience with what is known as the Medicare Settlement Conference Facilitation, or SCF. SCF represents a more effective and efficient way to resolve high volumes of Medicaid audit and demand for overpayment appeals.
Retain New York Medicaid Audits Lawyers
Not any lawyer will be able to provide optimal representation when it comes to a Medicaid audit matter. The laws and regulations associated with Medicaid audits and overpayment demands, and associated appeals, are complicated. The appeals process itself is complex and confusing to a person unfamiliar with it. In the end, only a lawyer with hands-on experience in this arena truly is capable of providing effective representation.
Todd Spodek
Lead Attorney & Founder
Featured on Netflix's "Inventing Anna," Todd Spodek brings decades of high-stakes criminal defense experience. His aggressive approach has secured dismissals and acquittals in cases others deemed unwinnable.
The initial step in hiring an attorney is scheduling an initial consultation. As a general rule New York Medicaid audit lawyers do not charge a fee for an initial meeting with a prospective client in a Medicaid audit-related case.
You are a physician who owns a multi-location urgent care practice in Queens, and you just received a notice from the New York State Office of the Medicaid Inspector General (OMIG) stating that a statistical sampling audit of your billing records over the past three years has identified $1.2 million in alleged overpayments. The notice demands full repayment within 30 days and warns that failure to comply could result in exclusion from the Medicaid program.
Can they really extrapolate overpayments from a small sample of my claims to my entire patient population, and what can I do to fight this?
Under New York Social Services Law §145-b and 18 NYCRR §518.4, OMIG is authorized to use statistical sampling and extrapolation to calculate overpayments, but their methodology must meet strict standards of statistical validity that can be challenged. You have the right to request an administrative hearing to contest both the sampling methodology and the individual claim determinations, and our firm has successfully reduced or eliminated extrapolated demands by exposing flawed sample selections and incorrect claim adjudications. It is critical that you do not ignore the 30-day deadline — instead, we can file a timely appeal and request a stay of the repayment demand while the case is reviewed. We can also negotiate a corrective action plan under 18 NYCRR §515.5 to protect your Medicaid enrollment status while we dispute the findings.
This is general information only. Contact us for advice specific to your situation.
During an initial consultation, a lawyer provides a general overview of a case, including possible defense strategies. The attorney will also respond to any questions you have, and provide you the additional information you may require to better understand the overall audit and appeals process.
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