Because Medicare and Medicaid claims audit requests can look like routine billing-related correspondence, they can be easy to miss, leading to expensive and potentially catastrophic consequences. Providers, therefore, should be prepared to identify and promptly and diligently respond to any audit requests from government contractors. This alert – the first in a three-part series – will explore the different types of audit contractors and their respective scopes of work to assist providers in identifying the contractors, the mechanics of their specific requests, and the issues they present. In future installments, we will discuss how to best respond to audits, the potential ramifications of negative results, and how to appeal negative audit results.
As discussed in the Bass, Berry & Sims Healthcare Fraud & Abuse Review, healthcare providers and suppliers (Providers) face increased government scrutiny from whistleblower lawsuits under the False Claims Act and government regulators pursuing civil and criminal healthcare fraud enforcement. A significant area of government scrutiny includes claims reviews by the Centers for Medicare & Medicaid Services (CMS) and its audit contractors to ensure CMS accomplishes its stated mission for program integrity to “prevent, detect and combat fraud, waste and abuse in the Medicare and Medicaid Programs.” A key component of CMS’s program integrity efforts includes different types of program integrity audits, often run by...
Patricia White, 70, of Old Greenwich, received a nine-month prison sentence for submitting false claims for unclaimed properties to around 30 state treasuries. HARRISBURG, Pa. — Months after her br...