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If you’ve recently received notice that you are under healthcare audit or investigation you’re probably feeling a big panicked. When the way you do business is questioned, it is natural to worry about what the researchers may find and if that information will be taken the wrong way.
But even though healthcare audits and investigations are things you and your medical practice must take seriously, you will need want to take moment before your respond to either an audit or an investigation. Before you begin, you need to understand what the audit and investigation means and what is expected from you.
What to Do If You’re Being Audited or Investigated
Before you do anything, read through your notice to determine if you’re being audited or investigated. While the two may seem similar, they actually have completely different contexts.
An audit appears when an organization or contractor wants to question an expense or a bill. If they believe you have been overpaid for a service or a treatment, they may request an audit to determine if that is actually what you should have received. Insurance providers and patients are the most likely individuals to request an audit.
While an audit looks into your charging process, they aren’t looking to determine if you have been dishonest or fraudulent. Instead, they are requesting additional information about how you got to the amount that was charged. During an audit, you will need to provide evidence of similar charges and an explanation for the price.
On the other hand, an investigation means that there is reason to believe you have been fraudulent in your charges. If you have been billing fraudulently or law enforcement has received a tip that you are engaging in unethical behaviors, your medical practice may come under investigation.
There are much more serious consequences that come from an investigation but it is possible for an audit to become an investigation. If during your audit the researchers find information that can be considered fraudulent, they may decide it is worth investigating.
Once you have determined if you’re being audited or investigated, you will want to contact a Dallas Healthcare Audits Investigations Lawyer. If you are unsure whether it is an audit or an investigation, an attorney can help you analyze your notice to determine the best path to take.
What Does a Dallas Healthcare Audits Investigations Lawyer Do?
The role of a Dallas Healthcare Audits Investigations Lawyer will depend on whether or not you are being audited or investigated. Their role may also depend on potential crimes that have been committed and what evidence investigators have found.
If you are only being audited, a Dallas Healthcare Audits Investigations Lawyer can guide you through the process to ensure it runs as efficiently and smoothly as possible. By helping you determine which information to provide to the auditors, an attorney can help you avoid any additional headaches or consequence during the auditing process.
A Healthcare Audits Investigations Lawyer can also help you during the auditing process to determine if there has been any fraudulent behavior that auditors may discover. If you can detect this behavior before auditors, you will be one step ahead if they choose to transform the audit into an investigation. This also gives your lawyer ample time to develop a defense if you should need to go to court.
If you are under investigation, it is absolutely crucial that you contact a Dallas Healthcare Audits Investigations Lawyer. An attorney can help you determine what billing or purchasing acts were illegal and advise you on how to best handle the investigation. An attorney can also protect you from making incriminating statements or sharing information that may hurt your case.
Depending on what investigators find, you or members of your team may face additional prosecution or trials. Fraud can be a criminal offense that may require jail time or the loss of your practicing license. If fraud or other illegal activity is discovered, you will want the expert assistance of an attorney.
Not only will an attorney help you defend yourself, but they can also help negotiate a settlement or shorter sentence if need be.