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If you are a healthcare provider and your practice has come under scrutiny in a Medicaid audit, you need an experienced healthcare lawyer to represent you. At Raiser & Kenniff, we are experienced with healthcare law and we bring our expertise to the assistance of both sole practitioners and large medical practices. With all our experience, we have learned that there are many different types of Medicaid audits a healthcare practice can face. Different approaches are necessary for different types of audit depending on what organization or contractor is handling the audit.
The Medicaid Integrity Program and fraud prevention
Medicaid audits are conducted to make sure that healthcare providers are not engaging in fraudulent activity by overcharging Medicaid for services for a patient. The Medicaid Integrity Program was implemented to ensure that Medicaid fraud can be identified and prevented. However, there are many different audit contractors that could engage in fraud prevention efforts by initiating an audit. Just a few of the relevant medicaid auditors are Recovery Audit Contractors, Comprehensive Error Rate Testing programs, and Medicaid integrity Contractors. An audit can also be initiated by a private insurance company.
Thus, there are many different types of Medicaid Integrity Contractor out there. However, all of these contractors fall under one three categories. there exist review Medicaid Integrity Contractors, educational Medicaid Integrity Contractors, and audit Medicaid Integrity contractors. Each of these three different types of contractor serves a different purpose in the process of conducting an audit on a healthcare provider charging Medicaid.
Those who provide medical services need to understand the complexity of the audit process when it comes to Medicaid. Handling an audit for a client requires not only a knowledge of administrative law, but also an understanding of how state and federal law also combine to affect the administrative aspects of the case in question. An audit can have devastating consequences for a healthcare practice if it is not handled properly. Doctors and other healthcare professionals need to recognize the fact that their livelihood is on the line if they are facing an audit. Expert legal counsel is therefore of enormous importance.
Responding to an audit
The following are four important tips for healthcare providers who are currently facing a Medicaid audit and need to find legal counsel for assistance:
Act quickly- It’s very important to respond right away to an audit. Waiting until close to any due dates that go along with your audit can put you at risk of neglecting to include some vitally important information. Due dates are important for auditors and any required information must be sent in to The Agency For Health Care Administration (AHCA) by the due date to avoid penalties.
Acquire a copy of all submitted claims- Keeping careful records of Medicaid claims is important because of the possibility of an audit. When you face an audit, you need to be able to quickly and conveniently come up with documentation of all of your claims.
Single out and develop explanation on any particular patient record that might incite scrutiny- If you already know that certain claims might receive particular scrutiny, single out these claims and include written information that you can present to your legal counsel and to the AHCA when necessary.
Compile information necessary for the Medicaid Provider Questionnaire- The Medicaid Provider Questionnaire is necessary in responding to an audit. You’ll need to make sure that every section on the form is filled out before submitting it to the AHCA in response to your audit.
Of course, the most important thing to do after you have been notified that you’re being audited is contact us. We are a New York law firm specialized in healthcare law.