Medicare Audits, Medicaid Audits, and Other payor Audits
In addition to our law firm’s experience representing healthcare entities subject to Recovery Audit Contractor (“RAC”) audits, Wachler & Associates, P.C., has also defended thousands of Medicare, Medicaid, and other third party payor audits over the past 20 years. Our attorneys have developed successful strategies for substantially reducing overpayment demands. We have fully developed legal analyses and have successfully applied legal defenses.
Medicaid Integrity Program
While many providers are focused on the Medicare Recovery Audit Contractor ("RAC") program, attention must also be paid to the Medicaid Integrity Program (MIP). MIP will consist of audits similar to those of the RAC program as a continued effort to increase detection, enforcement, and prevention of Medicaid fraud and abuse.
"The Medicaid Integrity Program: Full Steam Ahead," Andrew Wachler & Amy Fehn, The Health Lawyer, ABA Health Law Section, August 2009.
The Centers for Medicare and Medicaid Services (CMS) recently held a Special Open Door Forum to discuss the rollout of the MIP. Click here for highlights from that forum.
Medicaid Audits
Since 1980, our attorneys have represented Medicaid providers and suppliers in Medicaid audits. Medicaid providers and suppliers should be aware that there will soon be increased scrutiny of Medicaid claims. Section 6034 of the Deficit Reduction Act of 2005 (“DRA”) created the Medicaid Integrity Program, which formed the first national Medicaid provider audit program using Medicaid Integrity Contractors (“MICs”). These MICs are contracted to:
- Review provider claims;
- Audit provider claims;
- Identify overpayments; and
- Educate providers on payment integrity and quality of care.
Accordingly, Medicaid providers and suppliers should be prepared for increased scrutiny of claims submitted to Medicaid.
Third Party payor Audits
Our law firm has experience representing providers and suppliers that have been subject to claim denials and overpayment demands made by third party payors (e.g., Blue Cross). Our lawyers have successfully defended these types of audits and can assist your healthcare organization with these types of claim denials.
RAC and Medicare Audits
In the RAC demonstration program, our firm represented numerous hospitals and health systems, physicians & physician groups, hospice & home health agency ("HHA") providers, durable medical equipment ("DME") providers, skilled nursing facilities ("SNFs"), radiology providers, including independent diagnostic testing facilities ("IDTFs"), and ambulatory surgery centers ("ASCs") with their appeals of claim denials and overpayment determinations. Over more than the past 20 years, our attorneys have also represented over a hundred Medicare providers and suppliers subject to Medicare audits initiated by Medicare Intermediaries, Carriers, and Program Safeguard Contractors, with successful results.
Contact Us
Call us at 248-544-0888 or send us an e-mail to schedule a meeting to discuss your concerns with RACs or to discuss your other healthcare law-related needs.
