Defending Physicians From a Billing Audit in New York

If you face accusations of billing fraud, please read on, then contact an experienced New York billing fraud attorney to learn more about defending physicians from a billing audit in New York.

What happens in a New York billing audit?

Physician billing is one of the most common targets of auditing companies, who seek to determine whether the physician in question billed patients, or their insurance providers, too much money for their services. Often, the auditing company will only assess a small sample of what the physician has billed in order to ascertain any potential over-billing. After collecting and analyzing the data, the auditing company will develop a percentage of the alleged over-billing. Naturally, insurance companies will assume that the percentage of over-billing is a regular occurrence. Consequently, they will most likely issue a demand letter requesting the physician repay the over-billed amount.

What do you do after a billing audit in New York?

First and foremost, you should reach out to one of our skilled HMO / Medicare / Medicaid audit protection lawyers to discuss your next steps. A qualified legal professional will fully apprise you of your rights and responsibilities as well as provide guidance on how to navigate this complex and exacting process. Furthermore, a competent legal representative will help you lodge an adequate response to these attacks on your character. You will have two major approaches to take: settle with the insurance companies involved or fight against the claims.

How do you defend against billing fraud accusations?

As stated above, you can settle, fight or some combination of the two. If you choose the first option, you should try to settle for the lowest possible amount. But whether you settle or fight the claim, you and your attorney will have to prove the following:

  • The auditor did not conduct the test randomly
  • The audit can’t be relied upon
  • The allegations are without merit

When removed from their proper context, any billing period may seem suspect. The auditor might have had a predetermined goal in mind and purposely chose the most damaging and unrepresentative period to analyze. As such, he or she may have deliberately ignored instances in which you under-billed patients. It is crucial that you have an attorney to thoroughly examine your contract with the insurer. Sometimes, these contracts may contain an arbitration clause that states that an arbitrator must examine the dispute before either party makes any decisions. Without realizing it, your rights may have been violated.

These matters are too serious to face alone. Give us a call today.

Contact our experienced New York City firm

When a medical professional is accused of misconduct, they must retain strong legal representation. If you require a medical law attorney for your legal matters, call Paul E. Walker, an experienced New York City OPMC & OPD Lawyer. Please contact the Walker Medical Law firm to set up a free initial consultation.