If there are concerns that the finances associated with your healthcare office are not correct, then you could be audited. A healthcare audit lawyer is an option to consider so that you have someone on your side who can represent you if you have to go to court. Your attorney can help organize the financial information that you have and present it to the proper authorities whether you go to court or not so that there is no information missing.
Some of the reasons why you might experience a healthcare audit include an excessive number of errors in paperwork, notes that are missing, information about payments that are missing, and billing for services or prescriptions that are not needed or that are not provided in order to obtain more money from insurance companies.
Insurance companies will sometimes perform an audit if payments are underestimated. This is done so that the proper amount can be paid to the healthcare office whether it’s a higher or lower amount than reported. If the office is supposed to receive a lower amount than reported, then the difference in the payment would need to be made to the insurance company or to the court. Your attorney can examine the documents that you have and consult with an accountant who can offer details about what to possibly expect during the audit so that you’re prepared to make any payments that are necessary.
A sign that an audit could be on the way would be if an investigation or an outside company wants to look at the patient records that are kept on file. The party would then be able to decipher all of the treatments that have been provided and the appointments that the patient has been to before looking at payments that have been made by the patient, a private insurance company, or a state or federal insurance company. Once these records are reviewed, the party will likely want to view the financial records that have been kept by your office. Sometimes, a complaint by a patient is what triggers an audit to take place. At other times, an analysis by a computer system might detect information that doesn’t seem to match up with the payments that have been made and the records that have entered into the system.
If any kind of fraud is discovered, then your case will be handled by an investigator who will work to gather more information. You should already have an attorney in mind so that you can easily contact the person to represent you if you need to go to court. Once all of the documents have been reviewed, the investigator will then make a recommendation to the court as to whether or not to proceed with a trial. If there is enough evidence to show that fraud has occurred, then a trial will likely be on the horizon. You should meet with a healthcare audit attorney to review your records to see if there is a reason as to why the information might not be adding up if you know that you have done nothing wrong. You also need to talk to employees to see if there is any information that they have about any records that have been tampered with or if there have been any payments inappropriately handled. Documents and payment details will likely be examined by your attorney and the opposing side to make sure everything is covered in order to find out if fraud has occurred. At times, it could be a simple mistake on someone’s part, which is why you should have an attorney work with you during an audit.
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