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Health Care Audits Lawyers

A healthcare audit is a serious matter that can be a very stressful time when not dealt with by an experienced attorney. A healthcare audit is typically initiated by an insurance provider or a third-party. The audit is to review records that may be in question regarding payments made to the healthcare provider. An audit letter can be delivered in-person or through the mail. It’s a matter that requires immediate action and retaining an attorney as quickly as possible is always advised. This informative article will review some of the items regarding the auditing process and the effects it can have on a healthcare provider.

Healthcare Audits Explained

A healthcare audit can be initiated for one of many reasons. Often, the insurer that’s questioning claims will notice a pattern of unusual conduct such as a sudden increase in the number of claims being filed without any logical justification such as a public health matter. Whistleblower claims are also common and are usually initiated by a disgruntled former employee or someone that stands to benefit from the negative action. Current employees that are dishonest may also file false claims in order to embezzle. This is only a very small sampling of the reasons that an audit can be performed outside of the scope of spot checks and routine audits based on your contract.

Since Medicare and Medicaid are under strict scrutiny by the government and are especially susceptible to fraudulent claims, these are among the most common audits. Third parties that are contracted by insurers are often used to review over and underpayments, suspected fraud, and areas of medicine that are especially vulnerable to fraudulent claims.

How an Audit Works

Upon receipt of the letter advising you of an audit, you’ll be required to respond within a specific period. Ignoring the letter will only make matters worse and can subject you to significant fines and penalties. At this point, you’ll want to get in touch with a highly skilled healthcare attorney. It’s inadvisable to file your own response without legal representation. Typically, the attorney will ask the reasoning behind the audit to determine if it’s valid and necessary. They’ll file a response on your behalf. If all goes well, you might be able to avoid an audit altogether. If the insurer or contracted auditor still has a valid reason to proceed, a game plan will be put into action. Recordkeeping practices will be scrutinized during this time, so it’s important that everyone knows their job and how to keep accurate and thorough records. Should the audit go well, you’ll be finished with it. If not, you’ll most likely move towards an appeal or a hearing.

The Effects of a Negative Audit Result

Without the assistance of an attorney, an audit can go very wrong. You’ll be risking your ability to take certain insurance plans and can even be charged with insurance fraud on a local and federal level. Penalties and fines are typically hefty with these cases, so it’s important that you involve an attorney at the earliest point possible. With civil and criminal penalties at stake, this isn’t a matter that you’d want to take into your own hands, even if an expert on healthcare fraud and abuse. Unfortunately, the state and federal courts aren’t sympathetic to those who don’t want to hire an attorney. If the result remains negative after the case is resolved, an attorney would most likely be able to significantly have the fines, penalties, and any criminal ramifications reduced significantly. Our team will be happy to guide you through the healthcare auditing process and develop a winning strategy for you. Get in touch with us to schedule your appointment, today!

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Charle Butler
Charle Butler
2021-03-12
Verified
I was hesitant to hire the Spodek Law Group. I read reviews and knew they have a great reputation. However, I thought I would spend money and not see or speak to my attorney. From the beginning to end of my case Todd and the entire staff were available and willing to help. We worked towards and end result that was way above my expectation and Todd delivered. I am forever grateful for patience and long days and night spent working on my case. Thanks Todd and the entire team!
Mesonista parsons
Mesonista parsons
2021-03-05
Verified
My attorney at Spodek was Abigail. She was very knowledgeable and helpful with all my questions and concerns, as well as responsive. Her fees are affordable and Abigail took the time to make sure I understood everything relating to my case. I highly recommend Abigail and will request her services in the future.
debabrata chakraborty
debabrata chakraborty
2021-03-03
Verified
Todd A Spodek is the experienced and best criminal lawyer at USA. He is very professional and always respond on time. Alex also very cooperative and always help me. They took care me and my problem like family member. I am 100% satisfied for their professional service. My result was unexpected and amazing. They dismissed my case. I am really grateful to them. I will recommend you to go there if you want to solve your problem. I wish all the best for them.
Asata Hendricks
Asata Hendricks
2021-03-02
Verified
Truly appreciate the work the guys did!. Exceptional team & I know they care about each and everyone of their clients. I am super thankful to be referred to Spodek Law Group and I am grateful Todd & Alex were able to work diligently to achieve an outcome I am pleased with. Despite COVID they stayed on top of things and kept me informed every step of the way. Very thankful.
Mike Moroff
Mike Moroff
2021-02-26
Verified
I'm very satisfied with the services rendered by Todd, Alex and Mary Lou. I whole heartedly recommend Spodek Law Group . I've worked with and have retained other attorneys in the past with Todd's firm being the cream of the crop for many reasons. A very serious legal matter was resolved after a year's hard work and effort. Todd expertly guided me through the process and was able to navigate and make the good journey bearable as well as successful. Mary Lou initially provided excellent assistance before referring my case to Todd. Alex's support was effective and timely. The customer portal (MyCase) is an invaluable communication tool that also kept track of my case. Various aspects of my case were explained and there were several options provided but I made the final decision of how the case would be handled. The legal fee was reasonable considering the effort and amount of work plus it was a flat fee regardless of the length of time required to conclude my case. Todd made himself available to me and we had many scheduled meetings to go over the progress and to discuss the next steps. I felt more confident after many discussions with him. You will not go wrong choosing Spodek Law Group for legal matters.
Josh Katz
Josh Katz
2021-02-24
Verified
Being that it was the first time that I was in need of an attorney, I was afraid and hesitant and knew I needed the absolute best. It is beyond understood why Spodek Law Group has a reputation of being the top, if not the best law firm in New York. Alex and Abigail were there every step of the way even at the most unconvenient hours. I could not have asked for more. They are extremely good at what they do and they delivered much much more than just winning my case. A big thank you to Alex and Abigail for all the guidance and counseling and their upmost loyal support that extended far more than just legally. If you need the absolute best than don't hesitate to hire Spodek Law Firm.
L.C.
L.C.
2021-02-24
Verified
I cannot tell you how thankful I am to Todd and Alex for their hard work and dedication to my case. I had never been in any trouble before but I had an unfortunate event occur and in the midst of COVID-19 at that therefore I knew I needed a team that was dedicated to my success. Today- my case has been finalized and I’m walking away with no record and can continue life as a mother and a Grad student worry free. I cannot express enough gratitude for their assistance.
AnnMarie Soliman
AnnMarie Soliman
2021-02-23
Verified
I received a summons and called Spodek law group for a free consultation. Alex took my call and was very quick and responsive. He was available anytime through multiple platforms and very reassuring when needed. They are extremely organized and thorough. They got my case dismissed! I’m very grateful. Thank you Alex and Todd!

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"Spodek Law Group have offered me excellent support and advice thru a very difficult time. I feel I've dealt with someone who truly cares and wants the best outcome for you and yours. I'm extremely grateful for all the help Spodek Law Group has offered me. I can't recommend them..."

David Bruce

"Spodek Law Group was incredibly professional and has given me the best advice I could wish for. They had been helpful and empathetic to my stressful situation. Would highly recommend Spodek Law Group to anyone I meet."

Rowlin Garcia

"Best service I ever had. Todd is absolutely class personified. You are in the safest hands with spodek. They have their clients interest in mind."

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