How to Prevent an Audit or worse

The proliferation of health care fraud has resulted in almost every healthcare provider receiving a request for patient charts and being audited at least once during the life of their practice. When contacted to provide patient charts, it is recommended that you at least speak with an attorney to get an experienced legal review of the request. This is often a free consultation. The agency or company conducting the audit provides insight the reason for the audit – is it a truly random audit or is it a precursor to a civil or criminal prosecution.

When submitting claims two factors are key. First, the chart notes must be accurate and sufficiently detailed to justify the procedure code used. The hiring of a trained biller and coder can end up being cost-effective. It is good preventative medicine. By reviewing the chart notes, offering suggestions, and checking that the proper procedure code is used, the audit should result in no unexpected outcomes. Electronic billing programs that select procedure codes are only as accurate as the provider input. It is better to spend some time upfront and check the notes and charts before the claims are submitted.

Don’t be an outlier, but if you are . . .

If you are an outlier, a top biller of a procedure code, you are going to attract the attention of the OIG and likely a health care fraud United States Attorney. Doubly make sure that everything is properly documented, the procedure code used is accurate, and even have a law firm and an expert in billing and coding review your claims for accuracy. The benefit of hiring a law firm is to protect attorney-client privilege. Simply hiring an outside billing firm could result in that firm reporting you and trying to obtain a reward under the False Claims Act. A lawyer cannot act against his client’s interest and the outside consulting firm is hired as an agent of the firm.

“Attorney Rosenblat was exceedingly competent, diligent and attentive to my sensitive legal matter, which he resolved with aplomb. I am grateful for his professionalism and would highly encourage others to retain his services in the future.”

Case Studies

A medical practice was audited, and over $1.5 million was sought in recoupment to Medicare. All redeterminations and reconsiderations were filed, including an appeal to the Office of Medicare Hearings and Appeals. Medicare was unwilling to seriously enter into a settlement conference facilitation. A hearing was held before the OMHA and the administrative law judge ruled in favor of the provider.

A physician was contacted by the US Attorney and Medicaid Fraud Control Unit. Medical records were requested and produced. The initial demand from the government was single damages of over $400,000. (False Claims Act settlements are routinely settled for double damages, in this case over $800,000.) The final settlement amount was $75,000, $37,500 doubled.

Get to Know Us

What does Mike like to do besides practicing law and helping his clients? He is an avid runner and ran in this year’s Wine Glass Half Marathon in Corning, New York. He is also a supporter of the Fighting Illini and contributes to the IFund and the American Bar Foundation.

Legal Errors

With in-person court appearances no longer the rule, a lawyer appeared as a cat on a Zoom call when a filter was accidentally applied to his camera. You can watch the video below.

Lawyer Tells Judge ‘I’m Not a Cat’ In The Best Zoom Court Mishap Yet.

From Above The Law. To see the video click here.