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New York Medicaid Healthcare Audit Lawyers

March 21, 2024 Uncategorized

Most doctors believe that they can never get audited by Medicaid, but you will be surprised to know that any healthcare provider can get audited. Thousands of practices and experienced doctors get audited each and every year by Medicaid; while others are audited by other health-related entities such as private insurance companies and Medicare. Although such circumstances may be frightening if you have never been audited before, experienced Medicaid healthcare audit lawyers can assist you to get through such a situation with your practice unharmed.

Medicaid Audit Procedure

A Medicaid Audit only happens if Medicaid has any reason to believe that you are improperly billing them or you are fraudulent. Therefore, they can decide to request you for all the documentation that was submitted. This means that you will only get audited if something in your billing is deemed fraudulent. This can be a particular case or a coding pattern. There are many and different ways that you can get flagged for a Medicaid audit, and most of them don’t necessarily involve fraudulent activities.

In most cases, the auditor asks for copies of certain documents and records. They will always give a list of the documents they need, usually, in the first letter they send announcing their intention to audit your practice. After submitting the requested records and documents, the auditor will assess them and determine if further investigation is necessary.

After the investigation, the auditor can send a clearance letter, meaning that Medicaid is satisfied that no incorrect billing or fraudulent activities occurred. In other cases, you can be subjected to repayment of overbilling, heavy fines, cancellation of your ability to bill Medicaid, and in some cases jail time. Most doctors who have successfully come out of Medicaid audits unharmed had the assistance of qualified Medicaid healthcare audit attorneys.

Reasons Why Most Doctors Get Audited

Medicaid fraud is increasing across the country, and this adds more billions of dollars to the medical expenses incurred by states every year. This has resulted in Medicaid taking strict measures to counter these fraudulent activities. In most cases, Medicaid will identify some billing practices that, although not fraudulent, they can indicate high possibilities of fraud. Therefore, if you commit any of these red flags, you will most likely be red flagged for a Medicaid audit.

Although very few doctors will often commit fraud intentionally, many can break the rules unknowingly. For instance, doctors billing Medicaid for procedures that were performed by nurses, and that required on-site supervision. These small hitches can eventually be exposed during an audit and eventually cause severe consequences.

Christine Twomey
Christine Twomey
2024-03-21
Just had my Divorce case settled 2 months ago after having a horrible experience with another firm. I couldn’t be happier with Claire Banks and Elizabeth Garvey with their outstanding professionalism in doing so with Spodek Law Group. Any time I needed questions answered they were always prompt in doing so with all my uncertainties after 30 yrs of marriage.I feel from the bottom of my heart you will NOT be disappointed with either one. Thanks a million.
Brendan huisman
Brendan huisman
2024-03-18
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
2024-03-18
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
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Keisha Parris
2024-03-15
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko Beauty
Taïko Beauty
2024-03-15
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
Anthony Williams
2024-03-12
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
Loveth Okpedo
Loveth Okpedo
2024-03-12
Very professional, very transparent, over all a great experience
Bee L
Bee L
2024-02-28
Amazing experience with Spodek! Very professional lawyers who take your case seriously. They treated me with respect, were always available, and answered any and all questions. They were able to help me very successfully and removed a huge stress. Highly recommend.
divesh patel
divesh patel
2024-02-24
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.

What Can You Do After Receiving An Audit Letter From Medicaid?

The first and most important step after you realize that you are going to get audited by Medicaid is to read the letter carefully and get in touch with a qualified lawyer who has vast experience in this area. In most cases, the Medicaid audit letter will explain the reason as to why you are getting audited.

The letter will also contain the important documents that you are supposed to submit. Ensure that you submit these documents as soon as possible. Also, keep copies of all conversations with the auditor and any other persons involved in the audit. In some cases, your lawyer will advise you to submit more copies of the records and documents requested by the Medicaid auditor. This is especially if they can help to support your decision.

In case you are behind on paperwork, ensure you update them as soon as possible. However, remember not to make any changes to the existing documents. Most doctors are often tempted to expand their communication with their auditors to explaining their decisions, and this rarely ends well. Even making a slight change in existing records such as correct dating or adding any other correct information will make you look guilty.

How an Experienced Medicaid Audit Attorney Will Help You

Your Medicaid audit attorney will help you in several ways. First of all, your attorney will determine the reason as to why you are getting audited in case the auditor never made it clear in the letter. Secondly, your attorney will select documents that can assist in supporting your case. However, although it is necessary to submit all the files requested by the Medicaid auditor, the decision on whether to send more records will depend on your case.

Your attorney will also assist you to locate the best coding consultant to support you. In case you decide to find your consultant, any mistakes in your coding can be exposed to Medicaid. On the other hand, a consultant hired by your attorney will legally withhold such information.

An experienced attorney will also know the tricks often used by Auditors. Therefore, they can foresee the arguments the auditor will use and plan on how to defend you. Although most doctors have never been audited, experienced attorneys have helped several practitioners.

 

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