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In the healthcare industry, it is not uncommon to have finances and expenses under question. As everyone in the healthcare industry is attempting to run their own businesses, they want to ensure they’re not getting ripped off or spending money they don’t need to.
But when it comes to audits and investigations in the healthcare industry, they can actually have completely different intentions. If you are a healthcare professional and you’re going through an audit or an investigation, you will need to have a full understanding of what that means.
What is a Healthcare Audit?
Audits in the healthcare industry happen all the time. In an audit, you may have a bill or price of service questioned. When under audit, you simply need to provide the individual auditing you with additional information to support your price and explain how you came up with the number that you charged.
Audits can be requested by insurance companies, patients, Medicaid and Medicare, or may happen at random. The auditing process will depend on who is auditing you and what their purpose for auditing you may be.
An audit does not necessarily mean that illegal activity or fraudulent intent was present. Instead, they may just believe there was an error in billing or they would like to understand why your prices have been raised or you charge more than other medical practices in the area. ‘
While under a healthcare audit, it is important that you fully comply with the auditors. Although many audits are simply looking for ways to save money for insurance companies, Medicare, or Medicaid, audits can also unearth potentially fraudulent behavior that can come with serious consequences.
If you are under audit, you will want to consider hiring a Los Angeles Healthcare Audits Investigations Lawyer. While you can get through the audit without the help of an attorney, having an expert by your side can ensure you come out in the right light. By helping you determine which information you need to provide and what you should do and say during the audit, you can move on with your medical business as normal.
What is a Healthcare Investigation?
A healthcare investigation is much more serious than a healthcare audit. For the most part, audits are harmless and are simply looking for ways to save some money. While an audit not working in your favor could mean you need to return some cash, you don’t really need to risk losing your medical license or your business. With an audit, those reviewing your finances aren’t necessarily looking for a illegal behaviors.
But in a healthcare investigation, reviewers are looking for potential fraud or other illegal actions. Rather than simply reviewing your books and billings, someone investigating your medical practice will be looking for evidence or signs that you have not been following the law.
Investigations can be a bit more difficult to spark, but they usually begin by a tip that your practice is committing fraudulent billing practices. This may come from an employee or may even come from an auditing service that has recently performed an audit on your business.
Depending on the findings of an investigation, you or other responsible parties could face additional trials and potentially jail time. If anything, an investigation could ruin the reputation of your practice and your doctors.
Because of the serious consequences that can come from an investigation, you won’t want to go through the process without a Healthcare Audits Investigations Lawyers. With the help of a lawyer from the very beginning, you and your legal team can develop a defense for what activities the investigators will find. Additionally, an attorney can help negotiate a settlement or reduce potential jail time and consequences if illegal activity is found.
If you are being audited or investigated, don’t hesitate in contacting a Los Angeles Healthcare Audits Investigations Lawyer to see what they can do for you. The sooner you get legal help on your side, the better chances you have at coming out on top. With expert legal attorneys to walk you through the auditing or investigation process, you can ensure you did everything you could to win your case.