Healthcare Audit Defense

Healthcare Audit Defense and Compliance

All healthcare providers are at risk of being selected for the routine audit by Medicare, Medicaid, state licensing agencies, or private insurance companies. Of course, the thought of being audited is enough to give anyone nightmares. So, what can your organization do to reduce its chances of being selected, and to reduce errors that might be discovered if there is an audit?

Initiate a Compliance Program

Many overpayments to medical service providers are not attempts to perpetrate fraud, but the result of inadvertent billing or coding errors. And it is a known fact that certain billing practices increase your chances for selected for an audit. That’s why healthcare audit defense attorneys recommend that providers develop a billing compliance plan to help reduce such errors.

Conduct a Compliance Audit

To assist in the preparation of a compliance plan, a “snapshot” audit should be done to identify problems. This will provide a roadmap of areas that need to be addressed. Then, a healthcare audit attorney or other compliance expert can help ensure your documentation is in order, staff is properly trained, the appropriate regulations are reviewed, and necessary steps are in place to conduct self-audits to help prevent the real thing down the road.

If your practice or organization is selected for an audit, your healthcare audit defense lawyer will help ensure deadlines are met and important records are made readily available. They can instruct your staff on what to expect during the audit and how to engage, and respond to, the auditors.

Compliance Audit Defense

If you’re past the point of preparing a compliance plan and an audit is either imminent or has already begun, it’s even more critical to secure the services of an experienced healthcare audit defense attorney. If the auditing entity has already determined that you’ve been the recipient of overpayments, your lawyer will help in the appeals process.

Corrective Action Plan

An experienced healthcare audit defense lawyer can help you address and implement steps to ensure errors aren’t repeated in the future. Implementation of a corrective action plan will help mitigate penalties and let auditors know that measures are in place to prevent errors in the future.

Having a compliance plan in place should be the first step taken to ensure audits don’t happen. And if one does, an experience healthcare audit attorney will help ensure any issues uncovered are properly addressed. This is critically important as penalties may not stop at recovering fraudulent payments and can include revocation of billing privileges and criminal prosecution.