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Medicaid Healthcare Audit Lawyers

Audits for health care providers face different obstacles, depending on the type of health care they are providing as well as where the audit came from. Overpayment allegations can be made by several different Medicaid and Medicare audit contracts including Recovery Audit Contractors (RACs)and Medicaid Integrity Contractors (MICs).
These contractors have the objective of finding overpayment and fraudulent behavior by these health care providers and they each have a different way to audit an individual process. Because of this, providers can’t assume that because they have had an audit in the past that the approaching a new audit will be the correct way to proceed. Each contractor has their own audit process and they can also be different in what financial incentives they need to push for as their maximum recovery amounts. The contractors that receive compensation based on how much of the amount they recover will be less interested in negotiating than those that receive a flat fee.

Our attorneys are highly experienced and proficient in handling all forms of audits. Our attorneys have a tried and true strategic approached that we developed to each different type of audit based on vast knowledge and experience. Based on the unique details of your case, we can develop a plan of action to most effectively defend against the allegations you face.

Medicaid Audits
As a part of the effort to find and prevent Medicaid fraud, the Medicaid Integrity Program (MIP) was created and their audits are designed to detect fraud and errors and ultimately recoup any overpayments. MIP is executed by several Medicaid Integrity Contractors (MICs) who conduct the reviews and audits that help to identify and recoup any improper payments. These MIC’s act with the Medicaid agency in each state and provide oversight and technical aid. The requirements of the MIP allow CMS to hire MICs to review the claims and conduct the audits as well as to educate providers about the proper Medicaid claims compliance.

The MICs are split into three different types depending on what their main task is:
• Review MIC’s
• Education MIC’s
• Audit MIC’s

The review MIC’s identify providers that need to be audited and any potential reviewing claims that were submitted at least five years back.

The audit MIC then takes over the case and informs the provider with a notice of the audit and then requests records. In the early part of the audit, the provider will have an initial meeting with the audit MIC and it can then be determined if it is a field audit or a desk audit. In the early stages of the audit, the provider will also have an entrance conference with the audit MIC.

After the audit is finished, the audit MIC will submit a draft of the audit to the state Medicaid agency that will then review it and makes comments on whether the Medicaid policies in the state were followed correctly. After that, the report is forwarded to the provider who has 30 days to submit any additional comments or information within 30 days.
MIC’s are not compensated like RAC’s so they are not paid on a contingency basis and don’t even collect the overpayments. When the overpayments have been identified, the state will take over collecting the amount due from the providers and then the federal government gets its share directly from the state. State law governs any of the appeals from an MIC audit determination. Medicaid fraud, if found, can be criminally prosecuted either from the result of an audit or an investigation by the state or federal government.

Audits and appeals in Medicaid cases can involve many complex interactions of the state and federal law. Our attorneys are high experience in effectively negotiating the many complex laws to receive a successful outcome. Medicaid overpayment and fraud allegations can include criminal prosecution, fines, civil suits and also exclusion from the Medicare and Medicaid program.

Audits for Medicare focus on payment for service that were actually performed by the health care provider and that all service met the Medicare coverage conditions as well as were medically necessary. Genuine fraud does not need to be committed for an audit to occur. Mistakes in complicated paperwork or misinterpretation of contracts provisions as well as conflicting opinions on what medically necessary means can cause an audit to occur.

Health care providers that try to handle audits on their own often think that they didn’t do anything wrong so it should be easy to fix without help find that the audit process is very complicated. It’s important to contact an attorney to walk you through the many steps of an audit so that there aren’t any mistakes that cause you to lose resources and money while the audit process continues on. Our attorneys also know that many of the CMS contractors are paid based on how much money they recover so they have less interest in negotiating and will want to recover as much of the funds as possible.

Our attorneys can offer assistance to a health care provider at any step of an audit. Whether you were just notified of an audit or you are in the appeal stage, our attorneys can assess your case and come up with an individualized approach. Our highly qualified attorneys have extensive experience audits and appeals to help you get the most successful outcome possible.

Medicaid fraud is no laughing matter. It costs taxpayers millions of dollars every year, and is a major drain on the economy. If you are a healthcare provider who has recently been served notice of an upcoming audit, you will need to take these charges very seriously. Being convicted of medicaid fraud can result in imprisonment, ruinous fines, and the suspension or permanent loss of your license to practice. It’s important to hire a qualified medicaid healthcare audit lawyer immediately in order to ensure that you have professional legal representation at your upcoming hearing.

Professional Legal Representation Can Help You Avoid An Unpleasant Audit

When you receive your initial audit questionnaire, it’s important to have it examined by a trained legal professional as soon as possible. This will save you a great deal of worry, time, and money in the long run. Not only is it important to be able to provide the correct answers to the questions that are asked, but it is equally crucial that you have all of the records that are necessary to back up your version of events. The more documentation you have that supports the lack of fraud on your part, the better.

If Negotiation Fails, You Will Need To Go To Court

It’s important to try as hard as you can to negotiate a possible out of court settlement of your case. Doing so can avoid a great deal of tension and stress, as well as the loss of precious time and money. If your attorney can manage to negotiate a timetable for the repayment of the amount, or a settlement that is favorable to you, it’s in your best interests to agree to it immediately. The alternative is a long and costly battle in court that you will have to summon all of your strength and resolve in order to win.

This Is One Case You Simply Can’t Afford To Lose

One thing is certain: If you lose this case, you may end up losing thousands of dollars, as well as your license to practice in your profession. This is not a loss you can afford to take. The fines and interest fees that you may be charged on top of the amount you are judged to owe can be ruinous. A provider who is proven to owe $500 can ultimately end up being fined over 100 times that amount, to the tune of $50,000 or more. This can put a serious dent in your budget, as well as your professional reputation.

Instead of paying out such high amounts, a professional medicaid audit lawyer can help you find miscalculations and other errors in the audit report. The more of these that a lawyer can identify, the less you’ll eventually have to pay. A medicaid audit lawyer is your best bet to spot these inaccuracies and save you money. The sooner you hire a professional legal representative, the sooner you will be able to go to court with full confidence in your ability to win your case.


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."

Francis Anim
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