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Audits and investigations for New Jersey medical practices can be a stressful and confusing time. When your books, purchases, and charges are being scrutinized, it can be difficult to find time to relax. But when you allow yourself to stay stressed and worried, you aren’t able to make clear and well thought out decisions – which could potentially cost you your license and your practice.
If you are being audited or investigated, you need to understand what each means and what the potential outcomes are.
Healthcare Audits and Healthcare Investigations
While you may hear audits and investigations used interchangeably, it is important to note that they actually aren’t the same. Both an audit and an investigation will look into the way you are spending or charging at your medical practice, but the source of the research can actually make a huge difference.
If you have received a letter that you will be audited, this means that someone has requested to take a deeper look into your books and accounting. While that individual may believe that you are overcharging for services or making unnecessary purchases, an audit does not automatically assume that there is illegal behavior going on.
One of the most common reasons to be audited is if an insurance provider believes that you have overcharged them for a product or service. This overcharge may come from a disagreement in how much something costs, an opposing opinion, or even reason to believe that an error was made when sending the bill. In this audit situation, the insurance provider or other party requesting the audit is simply looking for additional information to better understand the charge.
Audits may also occur at random. Because the healthcare industry is always looking for ways to cut spending, your medical practice may receive notice of an audit simply because you were randomly chosen.
During an audit, it is important to fully comply and provide any necessary documents or materials to support your case. It is not uncommon to go through an audit only to find that no changes to how you’re spending or charging need to be made.
A healthcare investigation works a bit differently. Where an audit is simply requesting more information, an investigation stems from the belief that illegal activity is occurring, such as fraud. In an audit, overcharging or overspending is believed to be a mistake or a disagreement in cost. But in an investigation, there is reason to believe that you hope to illegally benefit from the extra money you’re seeking.
Investigations typically come from tips from employees of the medical practice or suspicious billing to insurance companies. Unlike a healthcare audit, healthcare investigations do not happen at random, so someone will need to file a complaint in order for an investigation to begin.
Depending on the circumstances surrounding an investigation, you, your practice, or responsible parties at your practice may face additional legal action. If fraud is found, you may face criminal or civil legal consequences depending on the kind and extent of fraud that has been discovered.
Working with an New Jersey Healthcare Audit Investigations Lawyer
If your medical practice is undergoing an audit or investigation, it is important that you contact an New Jersey Healthcare Audit Investigations Lawyer immediately. While an audit does not typically have the same consequences as an investigation, it is still important you understand what is expected of you and what information you need to give the auditors.
Through the audit process, an New Jersey Healthcare Audit Investigations Lawyer can help ensure the process runs smoothly and that any potential discrepancies the auditors find is clearly understood and explained. Because audits can easily change into an investigation, an New Jersey Healthcare Audit Investigations Lawyer can help protect you if the auditors find something they believe is worth investigating.
An New Jersey Healthcare Audit Investigations Lawyer is especially crucial during an investigation. Because you may face more serious consequences if an investigation unearths fraud, you will want an expert attorney by your side to help build a defense and negotiate a settlement that works in your favor.
As soon as you are alerted that an audit or investigation is about to take place, you will want to contact an New Jersey Healthcare Audit Investigations Lawyer.