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When your medical practice receives an audit letter, it is natural to worry or fear the potential outcome. Because an audit means the federal government believes you or someone at your practice has been making illegal or unethical claims, a healthcare audit could mean losing your practice or your license.
But even with such high stakes, panicking or worrying will only prevent you from focusing clearly on the situation at hand. In order to handle the case appropriately and ensure the audit ends in your favor, you will need a full understanding of what the situation means and what the potential outcomes are.
There are a few reasons why the government may send you a healthcare audit letter, but each audit depends on the way you’re spending money or how you charge for services.
The first kind of audit you may receive from the government takes a look at whether you’re overcharging for services. This audit is likely to be initiated by the insurance provider or by Medicare or Medicaid, but it may also happen randomly to help control the amount that doctors are charging for services. In these types of audits, your practice will be investigated to determine if the amount charged was accurate or if it believed that you attempted to receive additional compensation through the insurance claim.
With this type of audit, it is important to note that overcharging is not necessarily the same as fraud. A difference of opinion or an error in paperwork can also show that the insurance company overpaid without assuming that the physician attempted to receive money fraudulently.
Audits may also occur when medical equipment is purchased. If you receive an audit questioning medical equipment or services that you have charged for, your practice may be required to justify the amount of money spent. Again, these type of audits are only looking for additional information and does not necessarily assume that fraud has been committed.
When talking about healthcare audits and healthcare investigations, it is important to note that they are not interchangeable. With a healthcare audit, an insurance company or the government is simply looking to understand where your money is going and what can be done to reduce the cost of healthcare. You may be required to defend your spending or your pricing, but you will not necessarily have legal action taken against you or your practice if you are found to be overspending or overcharging.
An investigation is different because an investigation does assume that illegal activity has been happening. Rather than asking for additional support as they would in an audit, an investigation means the researchers have reason to believe you know you are overcharging and hope to reap a benefit from that extra cash.
Suspicious billing patterns are one way to spark an investigation, but it may also begin an audit. Investigations can also begin if an employee or patient makes a complaint or tips off law enforcement agencies that suspicious or illegal behavior is happening at the practice.
Depending on the truth behind a claim and what investigators find during their review, an investigation can mean serious consequences. If the investigators do not find any evidence or information that supports the claim of fraud, you and your practice will not face any additional consequences. However, if they find that the claim does hold up and is accurate, responsible parties may face criminal prosecution.
Anytime you are being audited or investigated, you will want to hire a Philadelphia Healthcare Audits Investigations Lawyer. As experts in the field, Philadelphia Healthcare Audits Investigations Lawyers can help you through the audit or investigation process.
With a helping hand, you can comply fully with your audit or investigation and maintain your practice and reputation. A Philadelphia Healthcare Audits Investigations Lawyer will help you understand what is expected and required from you during the audit or investigation process and can help you develop a defense if needed.
If you are currently under audit or investigation, don’t waste any more time. Contact a Philadelphia Healthcare Audits Investigations Lawyer as soon as you can.