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Preparing For a Medicaid Audit: How Los Angeles Medicaid Healthcare Audit Lawyers Will Assist You
If you are a healthcare provider in Los Angeles, you most likely have been reviewed by a Los Angeles Recovery Audit Contractor (RAC). After the healthcare reform legislation, RACs were given the power to review Medicare parts A, B, C and D claims. However; the healthcare reform was later expanded to Medicaid. Therefore, if you’re facing a Medicaid investigation, audit, or litigation process, you need qualified Medicaid healthcare audit lawyers in your corner, especially when replying to a Medicaid audit notice.
The primary purpose of Medicaid audits is to get answers to issues raised by government agencies. This means that you have to provide the correct responses to all the audit questions provided. Giving wrong answers can be used against you later, including in a litigation process. Some Medicaid proceedings can lead to criminal prosecutions. For instance, if the Medicaid auditor identifies that treatment to some of your patients was necessary, they can dig deeper. Such a review can cause further inquiries into your practice, lead to reimbursement for all losses incurred, and in some cases a suspension of your Medicaid number.
What You Should Know About Medicaid Audits
Most healthcare providers focus more on Los Angeles Medicare Recovery Audit Contractors. However, you should also pay careful attention to the Medicaid Integrity Program (MIP). MIP is a program that was created to detect and prevent Medicaid fraud. This program was mandated by the 2005 Deficit Reduction Act, and all states were required to hire Medicaid Integrity Contractors (MIC’s) to audit, review, and educate. MIP was also meant to recover Medicaid payments and provide technical support to state Medicaid agencies.
The Auditing Process
After you are chosen for a Medicaid audit, you will be referred to a MIC auditor who will perform the audit. The auditor will send a letter listing the records and documents you should submit. In some cases, the auditor will also explain why you are being audited. During the early phase of the audit, the auditor will set up an entrance conference.
Because auditors observe great discretion when performing a desk or field audit, you need to have a Los Angeles Medicaid audit lawyer to assist you. Unlike RAC’s, MIC auditors don’t have a limit to the medical records they can request. After completing the audit, the auditor will then prepare an audit report and share it with the California Medicaid agency to review and ensure that all Medicaid regulations are followed. The auditor will also issue you a copy of the report after which you will have a span of 30 days to either comment or submit more information.
It is common for the Medicaid Board to impose penalties against a licensed health care provider after the licensee has been sanctioned or audited by Medicaid. At such a point, you need to have a lawyer who can defend you from an unwarranted disciplinary action. After you have suffered sanctions or disciplinary action following administrative proceedings, your lawyer will apply the writs of mandate to pursue a judicial review of the action. A qualified lawyer will also combine the petition with a request for injunctive relief, for instance, a temporary restraining order to protect you. Although such petitions aren’t always granted, an experienced attorneys’ request will get approved.
Internet Prescription Penalties
Recently, the Board of Pharmacy has enforced regulations which prohibit pharmacists from filling prescriptions received via the internet. Pharmacies and pharmacists that are alleged to violate these laws are imposed to huge fines. The Board can impose fines exceeding $1 million, and in some cases over $10 million. The Medical Board of California also imposes additional fines on these healthcare providers.
These cases are often complicated due to the involvement of the DEA (Drug Enforcement Agency). This is because they involve the transportation of prescription drugs which are categorized as controlled substances. In such a case, the pharmacist is at a higher risk for criminal prosecution. Development of technical and factual defenses is necessary in such cases.
How Can a Qualified Los Angeles Medicaid Audit Lawyer Help You?
Your Medicaid audit lawyer will ensure that all your rights are protected. They will stand by your side from the initial process in responding to the Medicaid auditors’ notice, to appealing your case. If you have received a Medicaid audit notice, ensure that you talk to an experienced attorney. An audit can expose you to harsh administrative and financial penalties, including imprisonment, heavy fines, and forfeiture of your assets.