Like Medicare, Medicaid also carries with it numerous rules and regulations that must be strictly followed by doctors and other healthcare providers. Unfortunately, the rules associated with Medicaid billing change each year, making it more and more difficult to know whether or not your medical office is doing everything correctly. When questions arise concerning billing practices or other related areas, state and even federal investigators may step in and inform you they will be conducting a Medicaid audit of your practice and its billing statements. Should this occur, never try to handle this serious situation on your own. Instead, immediately contact a healthcare defense lawyer who has experience helping clients survive Medicaid audits without facing criminal prosecution.
Examining Financial Records
Just as it is when the IRS audits an individual, Medicaid investigators will closely scrutinize all financial records you have within your medical office that are linked to billing statements that have been sent to patients. Whether the wrong codes were used for various treatments, patients were billed for services that were never rendered, or simply that office workers failed to stay up-to-date on Medicaid billing regulations and thus made innocent mistakes during the process, the fact remains investigators will likely pursue charges against you. To make sure you are prepared for this and know the legal options you have available to prove your innocence, consult with and hire the services of a well-known healthcare defense lawyer you can trust.
Defending Your Actions
Since in many scenarios a doctor’s office had no intention of committing Medicaid fraud, it will be crucial you work with your healthcare defense attorney to plan a defense strategy that can defend your actions. To do so, you should always provide copies of all necessary financial records to your attorney. Once you have, they can examine them and also call in skilled forensic accounting investigators to examine the documents and act as an expert witness on your case. Once a skilled forensic investigator can examine your documents and reach a conclusion, they can file statements and testify in court that your records were not falsified or altered. In many situations, this can be a key part to swaying a jury in your favor.
Answering Investigator Questions
As in any situation where a person is facing criminal charges, you never want to answer questions directed at you by law enforcement or prosecutors without having your attorney present to give you sound legal advice. Unfortunately, many doctors and others make the mistake of thinking a Medicaid audit is not serious enough to warrant legal representation, which is a critical mistake. Since you will undoubtedly be asked many confusing questions by investigators in an effort to trip you up and have you make mistakes when giving your answers, never give answers to any questions until you have a healthcare defense attorney by your side who can advise you on what to say or not say.
A Strong Case Against You
In some instances, investigators may have a strong case against you in terms of evidence showing major discrepancies within your Medicaid billing procedures and statements. When this happens, you may be unable to prove your innocence. However, that does not mean all hope is lost. When these situations arise, having an experienced healthcare defense attorney working for you can make all the difference in terms of the actual charges that will be levied against you, the sentence you will receive, and also what will ultimately happen to your medical license and your practice. For example, if your attorney has proven the mistakes made were done so without the intent of fraud, a deal may be reached with prosecutors for a lighter sentence. Should you have numerous character witnesses who can testify on your behalf, it may even be possible to keep your medical license.
Though being informed by investigators that your medical practice will be audited on suspicion of Medicaid billing fraud, it is does not mean you will face criminal charges and ultimately lose your practice and license. Once you contact a healthcare defense attorney who understands how these cases often play out, they can get to work building a case that will result in minimal legal damage.
Along with doctors always having to be concerned about the quality of care they provide to their patients, they must also be knowledgeable about the role of insurance claims within their practice. One of the key aspects of this is Medicare Administrative Contractors, commonly known as MAC. Since the goal of MAC is to make sure no fraud takes place against Medicare, investigators are always on the lookout for discrepancies regarding Medicare payments and any claims that may be false or fraudulent. If you receive word your practice will be the subject of an upcoming MAC audit, take it seriously and immediately contact skilled healthcare defense MAC audits lawyers to provide expert legal advice throughout the process.
Keeping Accurate Records
When your practice is having a MAC audit occur, investigators will be asking for any and all records you have pertaining to billing for Medicare Parts A and B. To make your MAC audit go as smoothly as possible, it is best if you have very accurate records that you can give to investigators from the start. By doing so, you decrease the chances auditors will continue digging into your practice’s financial matters and attempt to make you look guilty. If you are being asked numerous questions by auditors in these situations, do not feel as if you are required to provide these answers on your own. Instead, work with your healthcare defense MAC audits lawyers to craft a careful, detailed, and honest response that will result in a successful outcome.
Auditors Make Mistakes
When MAC auditors arrive at your practice, do not assume they will perform their job perfectly. In fact, it is very common for auditors in these situations to make numerous mistakes. For example, they may incorrectly apply newer regulations to your audit when in fact older regulations were still in place at the time in question. Also, many auditors are eager to wrap up their investigations, and thus will simply jump to conclusions based solely on assumptions rather than facts. Finally, if they are inexperienced or perhaps feel as if they have total control over the finances of your practice, they may overstep their authority. If any of these acts happen, it can have a long-lasting impact on your practice and even your medical career. Rather than let this happen, always have healthcare defense MAC audits lawyers on your side who can carefully oversee the process and make sure you don’t become the victim of an overzealous government investigator.
Audits and Their Consequences
If your practice is under a MAC audit, the consequences could be severe depending on the outcome. For example, if Medicare fraud charges are determined to be true by auditors, your practice may have limited ability to bill for Medicare claims, and may also be forced into a prepayment review that could last at least six months. Also, should an auditor determine your practice made severe mistakes along the way regarding Medicare billing and payments, your practice may find itself being ineligible to participate in federal insurance programs. Should this happen, the financial impact could cripple your practice and force you out of business. Instead of letting the situation spiral out of control, hire healthcare defense MAC audits lawyers immediately upon learning a MAC audit will occur.
Avoiding an Audit
When these situations arise, it is vital to remember that just because you have been informed your practice will be the subject of a MAC audit does not necessarily mean it will ever take place. If you hire knowledgeable healthcare defense MAC audits lawyers quickly enough, they can assess your situation and sometimes prevent government auditors from ever setting foot inside the front door of your medical practice. However, in the event a MAC audit does take place and reaches conclusions you disagree with, your healthcare defense lawyer can advise you on the appeals process and other related matters.
As with any audit, many complexities are involved that require expert guidance from attorneys who handle such cases on a regular basis. If you and your medical practice are preparing to be the subjects of a MAC audit, schedule a consultation with healthcare defense MAC audits lawyers to discuss your situation in more detail.
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