FOLLOW US :
212-300-5196

White Glove Service. Excellent Results. Strong Reputation.

Read Our Reviews

Healthcare Audits and Investigations Lawyers

If you are a health care provider, then it’s essential you take proactive steps to keep your financial records as accurate as possible so that you don’t need to worry about the outcome of an audit. Staying safe means always using caution when you bill an insurance company so that you don’t get accused of overcharging. Getting audited does not always mean you will face negative consequences, but it can still be a stressful experience. Staying updated on related laws can go a long way to help keep you and your practice safe, but you cannot eliminate the odds of being audited entirely. It’s important you learn about the auditing process before you find yourself in the middle of it. Learning how to respond to an audit can be the difference between having the charges dropped and facing time in prison.

Audit Process

In some cases, insurance companies randomly adult health care providers so that they can spot instances of overpayment that might not be apparent right away, and you can do nothing to prevent this from happening. You will also be audited if you set off any red flags during the course of your job. For example, if an insurance company feels as though you have been overcharging for a service, they will take action to determine whether the related claims are legitimate.

Auditors will pay close attention to detail so that they can determine the accuracy of each record. During this time, they will check each claim to ensure it matches a corresponding patient record so that they can verify its legitimacy. If they find any discrepancies, their next step is to determine whether you made a mistake or tried to commit fraud.

Investigation

If a health care auditor determines you have overcharged the insurance company on purpose, then they will likely turn the situation over to a federal law enforcement agency. Rather than searching for mistakes, federal agents will now be looking for evidence of fraud and other criminal activity. If the federal agents do not find enough evidence to use against you, then they will drop the case, and you will not face charges. However, if they determine sufficient evidence is present, then you will be subject to prosecution and civil litigation. No matter the outcome, if an investigation gets this far, your career will be placed in jeopardy.

Responding to an Audit

When a health care auditor first decides to check your records, you are not likely to be notified. They don’t want you to take steps to protect yourself until they have enough evidence to use against you. It’s important you remember that evidence of an overcharge does not always result in criminal charges. But if the auditors believe you made a mistake, they will still expect you to pay back the amount you owe. Either way, they plan to take action by the time you realize they are auditing you. So, it’s vital you contact a lawyer right away so that you can have the best possible odds of winning your case. If an auditor tries to ask you questions, do not respond until you have spoken to a legal adviser. Otherwise, anything you say will likely be used as evidence against you, damaging the durability of your case.

Final Thoughts

Although being audited is a stressful experience, you do not need to feel powerless to protect yourself. The first step you must take to stay safe is to ensure all of your records are accurate. It’s also vital you use caution when entering a patient’s billing information so that your motives don’t get called into question by investigators. By the time an insurance company notifies you that an audit has taken place, the odds are already stacked against you. At best, you will be forced to repay any questionable claims. In the worst case, you will be put on trial for fraud, and you could find yourself in prison if your case goes downhill. If you want to stay safe from legal problems, then you must contact a lawyer the second you realize you are being audited or investigated so that you can build a strong defense.


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!

FREE CONSULTATION

Testimonials

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 enough.

~ 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.

~ Francis Anim

Spodek Law Group

White Glove Service

We provide superior service, excellent results, at a level superior to other criminal defense law firms. Regardless of where your case is, nationwide, we can help you.



Hear From Our Clients

"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."

Francis Anim
Read Our Reviews
Get In Touch

Schedule Your Consultation

Los Angeles

555 W 5th St 35th floor, Los Angeles, CA 90013

212-300-5196



get directions

Queens

35-37 36th St, 2nd Floor Astoria, NY 11106

212-300-5196



get directions

NYC

85 Broad St 30th Floor, New York, NY 10004

212-300-5196



get directions

Brooklyn

195 Montague St., 14th Floor, Brooklyn, NY 11201

212-300-5196



get directions

Call Us