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MAC Audits & Appeals Lawyers

Medicare Administrative Contractor Audits and Appeals and How They Can Affect Your Practice

If you’re in medicine, you’re most likely aware of the role that Medicare Administrative Contractors play in the scheme of insurance claims. A MAC audit can mean damaging results for your practice if not handled correctly. Insurance and billing issues must be audited properly and use the regulations that were applicable at the time of submittal. All too often, errors and miscalculations figure into the damaging effects of a poor audit. Your practice can lose the ability to participate in government insurance provider programs that are a necessity to the business. Serious penalties are also levied and can lead to significant financial peril. If your practice has been advised of an upcoming audit or investigation or you’re currently experiencing this, you need a highly skilled healthcare attorney on your side.

The Auditing Process and its Effects

The goal of MACs is to prevent the government from fraud and abuse on behalf of Medicare. Since MACs also are considered the “hub” for the fee-for-service auditing under the direction of the Centers for Medicare and Medicaid Services (CMS), they have a big responsibility to uphold. More specifically, they’re responsible for reporting Medicare overpayments and to recoup monies paid from false and fraudulent claims submitted by providers. Any provider that bills for Medicare Part A and Part B, home healthcare and hospice service providers, and durable medical equipment providers, are all subjected to MAC audits.

Recordkeeping practices are scrutinized during a MAC audit and should be in good order and complete. The more questions the auditor poses will most likely lead to additional digging for information. Involving an attorney can potentially thwart or at least reduce the impact the auditors have on your practice. Often, the auditors themselves make mistakes or misapply newer regulations that are invalid. They’ll come to illogical and erroneous conclusions based on assumptions rather than facts. It’s also common for them to seek recoupment on items that aren’t within their scope of authority. A skilled attorney will essentially go over the auditors work and pose their own questions. Many times, this intervention can lead to a favorable outcome for the provider rather than continuing to be raked over the coals.

Potential Hazards of Not Handling a MAC Audit Properly

If a MAC audit produces results that allege fraud and abuse, serious consequences are likely to take place. Medicare fraud charges can have a very serious impact on the practice’s ability to bill for Medicare claims and require a prepayment review lasting up to 6 months. If severe enough, the provider may be ineligible to participate in any federal insurance programs. This can cripple a practice and lead to its demise.

Acting Against MAC Audits

appeals and reconsiderations are a lengthy process that requires a considerable amount of time, money, and effort. It’s always best to avoid these things whenever possible. Attempting to handle the MAC audit or any legal claims that arise can be even more challenging and lead to significant [negative] outcomes. A skilled attorney can assess the level of threat that the practice may be exposed to and intervene properly. It’s even possible to avoid an unnecessary audit altogether if the audit is unwarranted or unjustified. Our offices have helped many clients in all aspects of healthcare law and defense matters. We’d be happy to review your case or any information you have about an upcoming MAC audit to see how we might be able to help. Get in touch with our offices by calling to schedule an appointment or contact us online, 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."

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"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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