Medicaid Audits: What Are They and What Could They Mean For Your Practice

Physicians and other healthcare professionals may be subject to Medicaid audits during their tenure as medical professionals. Medicaid audit contractors may audit a healthcare professional based on allegations of over-payment or other fraudulent conduct.  Sometimes, a simple error in your billing can raise a red flag and result in an audit.

Medicaid Integrity Program

The Medicaid Integrity Program (MIP) was created in an effort to detect, prevent, and penalize any provider that engages in Medicaid fraud.  Medicaid Integrity Contractors conduct reviews and audits to help identify any issues and recoup any over-payments or improper payments.  These contractors work directly with each state’s Medicaid agency in order to do so.  Although not an exclusive list, certain mistakes that may trigger an audit may be:

  • Errors in billing codes;
  • Sub-par documentation;
  • Billing incorrect services;
  • Unbundling services; and/or
  • Billing too frequently.

Should I Seek Legal Help if I am Audited?

Medicaid audits as a result of suspected fraud can involve complex interactions and laws.  Medicaid fraud may result in extreme consequences, such as large fines, civil lawsuits, exclusion from participating in Medicaid programs, and even criminal prosecution. It’s important to seek legal help in order to help you understand the laws.  Seeking legal advice can assist you in obtaining the best result for you and your practice, in the event of a Medicaid audit.

Any time your credibility as a medical professional is threatened, it is essential that you retain the services of an experienced medical defense attorney who has the skill you need to defend your future and protect your reputation.

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.