How a Medicare Audit Lawyer Protects Your Medical Practice

Medical facilities that submit claims to Medicare are subject to extensive regulation. Even well-intentioned providers can be audited in a way that jeopardizes revenue, workflow, and professional reputation. Knowing the purpose of a Medicare audit lawyer can help doctors and practice owners rest easy about how they will be able to safeguard themselves if/when an investigation occurs. 

Understanding Medicare Audits

Medicare audits are conducted by various government contractors, including Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), and Unified Program Integrity Contractors (UPICs). Billing patterns, documentation discrepancies, patient grievances, and other sources can prompt these audits. What may begin as a quest for records can escalate into requests for overpayment, payment suspensions, or accusations of improper billing. 

Since Medicare guidelines are somewhat complicated and change quite often, even a small mistake can turn into a significant problem. This is where lawyer representation comes into the picture. 

Acting as a Shield between You and Auditors

A Medicare audit lawyer is one of the ways you can defend your medical practice, as they can act as a mediator between you and auditors. This helps ensure that no messages are received out of order, misunderstandings don’t arise between client and attorney, and deadlines aren’t missed and inadvertently disclosed (to your detriment). Attorneys ensure that recorded responses are proper, complete, and not unnecessarily risky.

Early counsel is also helpful in controlling the scope of the audit so it doesn’t get out of hand and broaden beyond what was initially examined. 

Reviewing Billing and Documentation Practices

A Medicare audit attorney knows how to navigate the complexities of coding, medical necessity, and reimbursement. They can review your billing records and patient files to pinpoint weaknesses that auditors will question. This analysis enables your practice to proactively respond to problems, address documentation deficiencies, and implement corrective measures. 

Attorneys help avoid a bad outcome in complex audits by beefing up their compliance programs.

Managing Overpayment Determinations and Appeals

If the audit concludes that an overpayment has occurred, it may amount to a substantial sum. A Medicare audit attorney analyzes whether the auditor’s findings are grounded in law and evidence. The appeals process for Medicare is multi-layered and driven by deadlines, so it’s essential to seek legal guidance. 

A knowledgeable attorney can draft compelling appeals, send supporting documentation to substantiate them, and help you fight your way through each stage of appeal, including reducing or reversing demand amounts.

Supporting Long-Term Compliance and Risk Management

A Medicare audit attorney protects your practice beyond audits. Attorneys can help implement compliance programs, conduct internal audits, and train staff to minimize billing risks. Early involvement of legal is critical if an audit turns up evidence of fraud or abuse, and the circumstances under which penalties are not limited to monetary damages. 

Protecting Your Practice and Peace of Mind

Having an experienced Medicare audit attorney provides your medical or healthcare organization with representation, strategic direction, and protection throughout the audit process. With the right legal representation, providers don't have to worry about anything beyond treating patients and protecting their financial and professional interests.