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Medicaid is a government program that allows people who don’t have a large income to go to the doctor or to receive testing that they otherwise wouldn’t be able to afford. It can also be used to help pay for stays in the hospital or a nursing facility. Unfortunately, there are some concerns with medical offices when they have to audit doctors and other providers who tend to try to get more money from Medicaid.
A healthcare law firm represents everyone from dentists to hospitals who are involved with investigations and litigations. There are several issues that need to be addressed if someone is under an investigation with a Medicaid audit. The license of the doctor or nurse could be at risk as well as the license to operate at the office, nursing facility or the hospital. If the license is taken away, then the location would need to close until the issues have been remedied. Complete and organized records must be turned in to the audit team, and an attorney can help to ensure that these forms are completed like they should be so that the provider stands a better chance of remaining in business.
If a Provisional Agency Audit Report is received, it’s even more important to have all of the paperwork in order so that multiple payments to Medicaid are not made. This is a time to submit explanations for miscalculations, mistakes and other issues that have been reported. There are times that a demand for an over-payment might be requested. If the office or the provider has to pay back any money that has been received because there have been issues with getting more money from Medicaid, then it needs to be submitted as soon as possible so that it can be taken off of the record.
One of the ways that offices can get more money from Medicaid is to bill for multiple services that are provided when there is only one or two services that have been provided to patients. Some pharmacies will charge Medicaid for an expensive prescription while dispensing one that is less expensive. There are times when a pharmacy will bill for a medication that is expensive and give a patient that is completely different and cheaper but does the same thing as the one that is prescribed. Some doctors will submit codes for multiple services that were performed when they are supposed to submit combined codes. This is one of the common ways to get more from insurance companies like Medicaid. Most billing forms will combine common services, such as x-rays or blood work. The office would simply record individual services on multiple forms and change the date, making it look like there were several services that were provided for the patient on different days in order to get more money. If the patient doesn’t get a copy of the billing information from Medicaid, then the patient would never know that this was done.
Each dollar that is owed needs to be accounted for, and if the money can be shown, then it can end up saving the office hundreds in the final auditing process. This is where the attorney will be a benefit. The attorney can make sure the numbers that are recorded as they should be and that there are no errors with additions or subtractions. Other errors can also be discovered when the attorney looks at the paperwork that is submitted to the audit defense office. It could be something as simple as a number that needs to be changed or information about inventory that needs to be updated.